Altered Gut Microbiota Associated With Hemorrhage in Chronic Radiation Proctitis

Pelvic cancer radiotherapy may cause chronic radiation proctitis (CRP) that adversely affects patient’s quality of life, especially in patients with prolonged hematochezia. However, previous studies of radiation enteropathy mainly focused on acute irradiation hazards, and the detailed pathogenesis process and mechanism of prolonged hematochezia associated with radiation-induced toxicity remain unclear. In this study, we characterized the gut microbiota of 32 female CRP patients with or without hematochezia. Differential patterns of dysbiosis were observed. The abundance of Peptostreptococcaceae, Eubacterium, and Allisonella was significantly higher in CRP patients with hematochezia, while the compositions of the Lachnospiraceae, Megasphera, Megamonas, and Ruminococcaceae were lower in the microbiota of non-hematochezia patients. Functional prediction suggested significant difference in the expression of mineral absorption and the arachidonic acid metabolism proteins between hematochezia and non-hematochezia patients, possibly interdependent on radiation-induced inflammation. This study provides new insight into the altered composition and function of gut microbiota in patients with hematochezia, implying the potential use of probiotics and prebiotics for assessment and treatment of CRP.

Argon plasma coagulation for the treatment of chronic radiation proctitis – real-world data from Indonesian National Cancer Center

Background: This study aimed to evaluate the endoscopic features and clinical outcome of patients with chronic radiation proctitis (CRP) at one year after argon plasma coagulation (APC) treatment. Method: Between March 2016 and September 2019, a total of 48 female patients with CRP were treated with APC and their medical records were retrospectively reviewed. APC treatment was done every 3 to 54 weeks, with a median of 8 weeks. Number of APC was decided by the treating physician according to the severity of illness. Endoscopic and clinical features at one year after the final APC were recorded as the effectiveness of APC.Results: Of 48 patients, 26 patients were included in this study. Number of APC sessions varied between 1 to 5 sessions of APC for each patient. Of 26 patients, 22 patients achieved clinical improvement and four patients did not achieve clinical improvement at one year after the last APC session. Of the four patients who failed to achieve clinical improvement, two patients underwent surgery, one patient had occasional mild rectal bleeding, and one patient required regular transfusion. Of 22 patients with clinical improvement at one-year after the last APC, improvement of endoscopic features was found in 20 patients. Of four patients who did not achieve endoscopic improvement, diagnostic colonoscopy showed telangiectasis of more than 50% of rectal surface in 1 patient, presence of blood in 2 patients, and presence of ulceration of 1 cm in 1 patient.Conclusion: APC is an effective treatment option for CRP.

Surgical treatment of rectal bleeding in comorbid patients with chronic radiation proctitis

Radiation proctitis is a rare and significant complication of the combined therapy in patients with pelvic cancer. The choice of treatment of chronic radiation proctitis depends on the stage of disease and recurrent rectal bleeding. Comorbidity is cause to complicated proctitis. These clinical cases describe the choice and sequence of surgical interventions in order to achieve successful results in patients with chronic radiation proctitis.

Endoscopic treatment for chronic radiation proctitis

The preferred method in detection and staging of chronic radiation proctitis is colonoscopy. Moreover, endoscopy is used widely in treating patients with this disease. The main goal of endoscopic techniques is hemostasis and elimination of vascular transformations. This includes formalin application, band ligation, various types of laser irradiation, bipolar coagulation and cryotherapy. However, these methods are associated with relatively high risk of complications, whereas argon plasma coagulation and radiofrequency ablation are effective, relatively safe techniques for chronic radiation proctitis and well tolerated by patients.