Efficacy and Safety of Argon Plasma Coagulation for Hemorrhagic Chronic Radiation Proctopathy: A Systematic Review.

Yanan Peng,Shilin Fang,Qiu Zhao,Juerong Feng,Haizhou Wang,Meng Zhang,Jing Liu,Xianyan Shi,Ying Chang,Fan Wang

doi:10.1155/2018/3087603

Abstract

Hemorrhagic chronic radiation proctopathy (CRP) is a common complication after pelvic radiotherapy in patients with prostate or gynecological cancers. This systematic review was conducted to evaluate the efficacy and safety of argon plasma coagulation (APC) in treating hemorrhagic CRP. The databases of PubMed, Embase, and Cochrane Library were searched for related studies from inception to July 2017. Finally, 33 studies were identified with a total of 821 hemorrhagic CRP patients. After APC treatment, hemoglobin levels increased from 7.7–13.4 g/L to 11–14 g/L (including 15 studies). All (n = 33) studies reported an effective rate in rectal bleeding, among which five studies had a rate of 100%. Short-term complications were reported in 31 studies, while long-term complications in 33 studies and no complication in 11 studies. As for the severe complications, perforation was reported by 2 out of 33 studies, and the incidences were 3.3% (1/30) and 3.7% (1/27), respectively. As for APC setting, argon gas flow rate (median 1.5 L/min) and electric power (median 50 W) had no significant influence on complications and hemostasis. In conclusion, current literature indicated that APC therapy was an effective and safe strategy for hemorrhagic CRP, and large-scale prospective studies are needed to warrant our study.

Highlights

Hemorrhagic chronic radiation proctopathy (CRP) is a common complication after pelvic radiotherapy
As an easy method in destructing the telangiectasias caused by radiotherapy, argon plasma coagulation (APC) was reported to have a better efficacy than formalin in treating hemorrhagic CRP (79% versus 27%, P = 0 017) [4]
Alvaro et al found that APC therapy had a significantly better response than hyperbaric oxygen therapy in reducing blood transfusion and tissue toxicity, both treatments showed no significant difference in resolving rectal bleeding

Summary

Introduction

Hemorrhagic chronic radiation proctopathy (CRP) is a common complication after pelvic radiotherapy. It had an incidence of 5% to 15% in the patients of pelvic cancers within 6 months after radiotherapy [1]. As an easy method in destructing the telangiectasias caused by radiotherapy, argon plasma coagulation (APC) was reported to have a better efficacy than formalin in treating hemorrhagic CRP (79% versus 27%, P = 0 017) [4]. Sato et al found that appropriate APC settings (e.g., electric power, application time, and argon flow rate) could reduce the damage to deeper tissues, decreasing the incidence of complications [11].

Methods

Results

Discussion

Study design

Study design Age

Conflicts of Interest