Review article: current therapeutic options for radiation proctopathy

Radiation proctopathy is a common unfortunate complication following radiat ion therapy of pelvic malignancies. Symptoms of chronic radiation proctopat hy include haematochezia, urgency, constipation, tenesmus, diarrhoea and re ctal pain. Currently, a wide variety of pharmacological options, endoscopic cautery te chniques and surgical procedures have been proposed for the treatment of ch ronic radiation proctopathy. Although these have been proposed primarily as treatment for rectal bleeding, the control of other symptoms has been note d with some of these agents. Pharmacological options include 5-aminosalicyl ic acid preparations, coticosteroid enemas, sucralfate (oral, enemas), form alin, short chain fatty acid enemas, oestrogen/progesterone, hyperbaric oxy gen, antioxidants, sodium pentosan polysulphate and misoprostol rectal supp ositories. Of these, sucralfate and formalin therapy appear to be effective for bleeding control. Misoprostol rectal suppositories and oral sucralfate may be useful in the prevention of acute and chronic symptoms of radiation proctopathy. Endoscopic cautery techniques have included the use of Nd:YAG laser and arg on laser for coagulation of bleeding neovascular telangiectasias. Argon pla sma coagulation offers a safe non-contact method of delivering haemostasis which has proven to be particularly useful in targeting difficult to reach lesions tangentially. Surgery is generally reserved for severe refractory cases involving ongoing haemorrhage, obstruction, stricture formation, fistulas and perforation. G iven that formal randomized placebo-controlled studies are lacking for most treatments, the management of these patients is often challenging and uncl ear. Hence, there is a need for more research and education on radiation pr octopathy.