Efficacy of Radiofrequency Coagulation in Managing Chronic Radiation Proctitis

Abstract

Purpose: Radiation therapy is a modality frequently utilized to manage pelvic malignancies from a primary, post-operative adjuvant, or palliative approach. Despite the high prevalence of post treatment chronic radiation proctitis (CRP), medical management is not clearly defined or standardized. The purpose of our study was to evaluate the feasibility of radiofrequency energy (RFE) in treating CRP compared to that of the traditional coagulation modality of argon plasma coagulation (APC). Methods: We performed a prospective randomized study comparing standard APC and RFE in patients with symptomatic CRP and their effect on common outcomes. Patients enrolled in the study had pelvic malignancy treated with radiotherapy and subsequent history of chronic radiation proctitis (defined as development of proctitis at least 90 days from end of radiation treatment). Proctitis was scored based on RTOG (Radiation Therapy Oncology Group) and Vienna endoscopic scoring system. Primary study endpoint was reduction or absence of bleeding episodes requiring no further endoscopic treatment after 6 months. Secondary endpoints included time to resolution of symptoms, and need for further blood transfusions. Independent Student T-test was utilized to compare mean primary and secondary endpoints. P-value of 0.05 was considered statistically significant. Results: To date, a total of 7 patients have been assigned to either RFE (n=4), or APC (n=3) group. Mean patient age for both groups was 76.7 years (64 to 83; SD: 5.94). Average amount of prior radiation dose used in treatments for pelvic malignancy in the RFE group was not significantly different from APC group. Average baseline frequency of bleeds/week in the RFE group (M = 6.5 times/week; SD: 3.3) were not significantly different than the APC group (M = 3.67 times/week; SD: 2.9). Baseline RTOG scores in the RFE (M = 1.5; SD: 0.6) group were not significantly different from the APC (M = 1.3; SD: 0.6) group (p = 0.58). The frequency of bleeds at first follow up were significantly higher for the RFE (M = 4.3 times/week; SD: 3.4) group than the APC (M = 0.3 times/week; SD: 0.6), p = 0.025. Mean RTOG score at second follow up visit was higher for RFE group (M = 1.5; SD: 0.91) than it was for the APC group (M = 1.0; SD: 0), p = 0.007. There was no difference in RTOG scores at third follow up visit for RFE group (M = 1.33; SD: 0.6) and APC group (M = 0.2 SD: 0.70), p = 0.72. Conclusion: While the APC group appears to have better control over limiting frequency of bleeding, RFE may control CRP bleeding as efficaciously as APC in terms of reducing patient symptom severity, time to resolution of bleeding, and need for blood transfusions. Further larger longitudinal studies are needed to confirm these findings.