Radiation proctitis. Clinical and pathological manifestations, therapy and prophylaxis of acute and late injurious effects of radiation on the rectal mucosa.

BACKGROUND: Often the rectum is the dose-limiting organ in curative radiation therapy of pelvic malignancies. It reacts with serous, mucoid, or more rarely bloody diarrhea.
METHODS: A research for reports on prophylactic and supportive therapies of radiation-induced proctitis was performed (Medline, Cancerlit, and others).
RESULTS: No proven effective prophylactic local or systemic therapies of radiation proctitis exist. Also, no reasonable causal medication is known. In the treatment of late radiation sequelae no clinically tested certain effective therapy exists, too. Antiinflammatory, steroidal or non-steroidal therapeutics as well as sucralfate can be used as topical measures. They will be successful in some patients. Side effects are rare and the therapy is cost-effective. Treatment failures can be treated by hyperbaric oxygen. This will achieve good clinical results in about 50% of the cases. Single or few mucosal telangiectasias with rectal bleeding can be treated sufficiently by endoscopic catheterization.
CONCLUSION: Besides clinical studies acute proctitis should be treated just symptomatically. Radical surgery should be performed only when all conventional treatments have been uneffective, although no certain effective therapies of radiation-induced late proctitis exist.