Radiation Proctitis: The Potential Role of Hyaluronic Acid in the Prevention and Restoration of Any Damage to the Rectal Mucosa among Prostate Cancer Patients Submitted to Curative External Beam Radiotherapy

Aim: To evaluate if hyaluronic acid reduces proctitis episodes with respect to corticosteroids in prostate cancer patients submitted to radical or adjuvant radiotherapy. Methods: A consecutive series of eligible patients received hyaluronic acid enemas as supportive care (experimental group, from January 2013 to June 2015). A historical group (control group), treated from October 2011 to December 2012, received beclomethasone dipropionate suppositories. We registered each patient’s data regarding acute and chronic proctitis. All patients were treated with static-intensity-modulated radiotherapy coupled to a daily set-up verification with orthogonal anterior–posterior/lateral X-ray pairs. Results: A total of 269 patients, 175 in the experimental group and 94 in the control group, was evaluated; 2 Gy/day (up to a total median dose of 80 Gy) and 2.7 Gy/day (up to a total median dose of 67.5 Gy) fractionation schemes were used for 216 and 53 patients, respectively. All patients had a good tolerance to radiotherapy, reporting no G3 or greater proctitis. No significant difference was reported concerning the total rate of proctitis between the two groups but only with respect to its grade: a higher G2 rate within the control group. There was no correlation between daily dose fractionation and toxicity grade. Conclusions: Hyaluronic acid enemas might be effective in reducing the severity of radiation proctitis.

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.