ENDOSCOPIC VS COMBINED MEDICAL AND SURGICAL MODALITIES OF TREATMENT OF RADIATION INDUCED PROCTOCOLITIS – OUR INSTITUTE EXPERIENCE

Abstract

Background: GIGastrointestinal injury may occur following irradiation of thoracic,abdominal,and pelvic malignancies limiting radiation doses that can be delivered as well as causing significant morbidity requiring intervention. Radiation proctocolitis, both acute and chronic, is one such complication requiring multidisciplinary management for good outcomes.We analyzed the injury with respect to spectrum of injury, severity, morbidity and compared endoscopic vs combined medical and surgical modalities of treatment. Methods: Patients with acute and chronic radiation proctocolitis defined as illness presenting before and after 3 months respectively,of radiation treatment were included in the study.The study period was five years. Results: Total number of patients studied were 75.Acute disease was seen in 5 patients,presenting predominantly with diarrhea, abdominal pain and acute intestinal pseudo-obstruction. Chronic radiation proctocolitis was seen in 70 patients. Bleeding per rectum was the most common symptom. Anemia was the commonest sign. Grade 2 injury was most commonly seen. Pharmacotherapy was equally effective in grade 1 injury whereas Endoscopic treatment was superior to pharmacotherapy in Grade 2,3. Surgery offered lesser rates of rehospitalization in grade 3 but was associated with higher complications. There were no deaths in endoscopic arm while there were 2 deaths in pts who required surgery. Surgical combined with medical was superior to endoscopic treatment in grade 4 while local agents were ineffective.Preventive strategies prior to radiation were associated with lower grade of injury. Conclusion: Radiation proctocolitis causes significant morbidity requiring prolonged treatment and hospitalization. Dose and duration of radiation had direct relation to the severity of injury. Concurrent chemotherapy had no effect on severity of injury.Our study showed acute proctocolitis required predominantly supportive medical treatment.Chronic form from grade 1 to 3 required predominantly endoscopic treatment with prolonged duration of treatment but less morbidity.Grade 4 required surgical and intensive care and local therapy was ineffective.