Abstract
Introduction. Persistent radiation-induced proctitis and rectal bleeding are debilitating complications with limited therapeutic options. We present our experience with ozone therapy in the management of such refractory rectal bleeding. Methods. Patients (n = 12) previously irradiated for prostate cancer with persistent or severe rectal bleeding without response to conventional treatment were enrolled to receive ozone therapy via rectal insufflations and/or topical application of ozonized-oil. Ten (83%) patients had Grade 3 or Grade 4 toxicity. Median follow-up after ozone therapy was 104 months (range: 52–119). Results. Following ozone therapy, the median grade of toxicity improved from 3 to 1 (p < 0.001) and the number of endoscopy treatments from 37 to 4 (p = 0.032). Hemoglobin levels changed from 11.1 (7–14) g/dL to 13 (10–15) g/dL, before and after ozone therapy, respectively (p = 0.008). Ozone therapy was well tolerated and no adverse effects were noted, except soft and temporary flatulence for some hours after each session. Conclusions. Ozone therapy was effective in radiation-induced rectal bleeding in prostate cancer patients without serious adverse events. It proved useful in the management of rectal bleeding and merits further evaluation.
Highlights
Persistent radiation-induced proctitis and rectal bleeding are debilitating complications with limited therapeutic options
The incidence and severity of late effects of RT depend on dosimetry factors, fractionation, technique for radiotherapy delivery, and patient factors
We have used the Common Terminology Criteria for Adverse Events (CTCAE) toxicity scales focusing on hemorrhagic symptoms
Summary
Persistent radiation-induced proctitis and rectal bleeding are debilitating complications with limited therapeutic options. Ozone therapy was effective in radiation-induced rectal bleeding in prostate cancer patients without serious adverse events. It proved useful in the management of rectal bleeding and merits further evaluation. The incidence and severity of late effects of RT depend on dosimetry factors (total dose of RT, rectal volume exposed to high doses, and 2D versus 3D conformation), fractionation (fractions of RT dose administered each day), technique for radiotherapy delivery (external beam radiotherapy versus brachytherapy), and patient factors (such as previous inflammatory colitis disease, vascular diseases as in diabetes which could adversely affect the healing process, and antiaggregant or anticoagulant treatments which can encourage bleeding [1, 2]). Radiation proctitis and RB remain relevant side effects following treatment of this tumor.
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