Argon plasma coagulation for rectal bleeding after prostate brachytherapy

Purpose: To better define the efficacy and safety of argon plasma coagulati on (APC), specifically for brachytherapy-related proctitis, we reviewed the clinical course of 7 patients treated for persistent rectal bleeding. Appr oximately 2-10% of prostate cancer patients treated with I-125 or Pd-103 br achytherapy will develop radiation proctitis. The optimum treatment for pat ients with persistent bleeding is unclear from the paucity of available dat a. Prior reports lack specific dosimetric information, and patients with wi dely divergent forms of radiation were grouped together in the analyses. Methods and Materials: Seven patients were treated with APC at the Veterans Affairs Puget Sound Health Care System and the University of Washington fr om 1997 to 1999 for persistent rectal bleeding due to prostate brachytherap y-related proctitis. Four patients received supplemental external beam radi ation, delivered by a four-field technique. A single gastroenterologist at the Veterans Affairs Puget Sound Health Care System treated 6 of the 7 pati ents. If the degree of proctitis was limited, all sites of active bleeding were coagulated in symptomatic patients. An argon plasma coagulator electro surgical system was used to administer treatments every 4-8 weeks as needed . The argon gas flow was set at 1.6 L/min, with an electrical power setting of 40-45 W. Results: The rectal V100 (the total rectal volume, including the lumen, rec eiving the prescription dose or greater) for the 7 patients ranged from 0.1 3 to 4.61 cc. Rectal bleeding was first noticed 3-18 months after implantat ion. APC (range 1-3 sessions) was performed 9-22 months after implantation, Five patients had complete resolution of their bleeding, usually within da ys of completing APC. Two patients had only partial relief from bleeding, b ut declined additional APC therapy. No patient developed clinically evident progressive rectal wall abnormalities after APC, (post-APC follow-up range 4-13 months). Conclusions: Most patients benefited from APC, and no cases of clinically e vident progressive tissue destruction were noted. Although APC appears to b e efficacious and safe in the setting of the rectal doses described here, c aution is in order when contemplating APC for brachytherapy patients. (C) 2 001 Elsevier Science Inc.