Radiofrequency ablation for the treatment of radiation proctitis

Background and study aims: The main endoscopic therapy for radiation proctitis is argon plasma coagulation (APC); however treatment is not always successful. Radiofrequency ablation (RFA) is a possible treatment for radiation proctitis but data are scarce. The aim of this study was to report on the safety and efficacy of RFA in the treatment of radiation proctitis. Patients and methods: This study was an open-label, retrospective, multicenter study of patients with chronic hemorrhagic radiation proctitis who were treated with RFA. Data included a three-item symptom score, the number of packed red blood cell transfusions, the lowest hemoglobin concentration, and complications, during the 6 months prior to and after RFA. Clinical success was defined as a decrease in the symptom score. Biological success was defined as an increase in the hemoglobin rate with equal or decreased number of transfusions required. Results: A total of 17 patients underwent a median of 2 RFA sessions (range 1-4), without perioperative complications. Symptom scores decreased in 16 patients (clinical success 94%), from a mean score of 3.6 (median 4) to 1.4 (median 1) (P<0.01). Two patients developed rectal ulceration, with no local symptoms. During the 6 months after RFA, hemoglobin concentration increased in all 17 patients (from mean 8.3 +/- 2.8 g/dL [median 7.5] to 11.3 +/- 2.2 g/dL [median 11.0]; P<0.01). Among 13 patients who were transfusion dependent prior to RFA (mean 7.2 +/- 7.7 transfusions [median 4]), 9 patients (69 %) were weaned off transfusions after RFA. A significant increase in the hemoglobin level was observed in this subgroup of patients (from mean 7.2 +/- 1.4 g/dL [median 7.3] to 10.7 +/- 1.5 g/dL [median 10.5]; P<0.001). Biological success was 100%. Conclusions: RFA seems to significantly decrease clinical symptoms and increase the hemoglobin concentration, thus reducing the need for transfusions.