Radiation proctitis - a review

Abstract

Acute radiation proctitis is usually transient and self-limiting while chronic radiation proctitis is frequently relentless and progressive if untreated. The actual incidence of acute and chronic radiation proctitis is difficult to determine due to the sparse number of prospective studies available. The management of chronic radiation proctitis has so far been unrewarding as treatment options are limited, and of varying and inconsistent efficacy. Therapeutic strategies are not well defined and there is lack of consensus on the standard therapeutic strategy. Clinical response to different forms of treatment are also difficult to predict even though endoscopic interventional modalities utilising argon plasma coagulation and formalin application have shown promising results \ and are beginning to emerge as effective first line agents in the management of chronic radiation proctitis. Surgical intervention is associated with high risk of complications because of the impaired healing potential of surrounding irradiated tissue and is usually reserved for unrelenting symptoms or the development of fistulation to surrounding pelvic organs. This paper reviews the clinical features, pathology and management issues related primarily to chronic radiation proctitis.