Review article: current therapeutic options for radiation proctopathy J. J. HONG*, W. PARK  & E. D. EHRENPREIS* *Gastroenterology Division, Department of Medicine, University of Chicago, Pritzker School of Medicine;  Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA Accepted for publication 25 April 2001 INTRODUCTION Radiation proctopathy is de®ned as damage to the rectum or rectosigmoid colon which results from radiation therapy to adjacent pelvic organs for the treatment of pelvic malignancies. Malignancies of the prostate, cervix, uterus, bladder, testicles and rectum, as well as lymphomas, are commonly treated with pelvic irradiation. Of these, radiation treatment for prostate cancer is the most common. External beam radiation therapy represents the main form of treatment of prostate cancer. Implantations with high dose rate intracavitary brachytherapy are utilized for large tumours or advanced disease. 1 With delivery of radiation to the prostate, a portion of the rectum is included in the ®eld of treatment. A standard dose of 65±70 Gy of conventional exter- nal beam radiation therapy to prostate carcinoma can exceed the tolerance of the normal rectal mucosa, and may result in substantial late gastroin- testinal complications, including rectal bleeding, SUMMARY Radiation proctopathy is a common unfortunate complication following radiation therapy of pelvic malignancies. Symptoms of chronic radiation procto- pathy include haematochezia, urgency, constipation, tenesmus, diarrhoea and rectal pain. Currently, a wide variety of pharmacological options, endoscopic cautery techniques and surgical procedures have been proposed for the treatment of chronic radiation proctopathy. Although these have been proposed primarily as treatment for rectal bleeding, the control of other symptoms has been noted with some of these agents. Pharmacological options include 5-aminosalicylic acid preparations, coticosteroid enemas, sucralfate (oral, enemas), formalin, short chain fatty acid enemas, oestrogen/progesterone, hyperbaric oxygen, antioxidants, sodium pentosan polysulphate and miso- prostol rectal suppositories. Of these, sucralfate and formalin therapy appear to be effective for bleeding control. Misoprostol rectal suppositories and oral sucralfate may be useful in the prevention of acute and chronic symptoms of radiation proctopathy. Endoscopic cautery techniques have included the use of Nd:YAG laser and argon laser for coagulation of bleeding neovascular telangiectasias. Argon plasma coagulation offers a safe non-contact method of delivering haemostasis which has proven to be particularly useful in targeting dif®cult to reach lesions tangentially. Surgery is generally reserved for severe refractory cases involving ongoing haemorrhage, obstruction, stricture formation, ®stulas and perforation. Given that formal randomized placebo-controlled studies are lacking for most treatments, the management of these patients is often challenging and unclear. Hence, there is a need for more research and education on radiation proctopathy. Correspondence to: Dr E. D. Ehrenpreis, Gastroenterology Division, Uni- versity of Chicago, Pritzker School of Medicine, 5841 S. Maryland Ave MC 4076, Chicago, IL 60637, USA. E-mail: eehrenpr@medicine.bsd.uchicago.edu Aliment Pharmacol Ther 2001; 15: 1253±1262. Ó 2001 Blackwell Science Ltd 1253