Barış YILMAZ, Fuat EKİZ, Ömer BAŞAR, Şahin ÇOBAN, Zahide ŞİMŞEK, Murat DEVECİ, Akif ALTINBAŞ, Bora AKTAŞ, Osman YÜKSEL

Radyasyon proktitinde argon plazma koagulasyon tedavisinin etkinliği

Proktit, pelvik bölge kanserlerinde uygulanan radyasyon tedavisinin uzun dönem komplikasyonuolarak görülebilir. Radyasyon proktitinin kesin tedavisi konusunda halen bir kafa karışıklığı vardır.Argon plazma koagulasyon (APC) tedavisi en kabul gören tedavi yöntemidir. Kliniğimizde ikiyıllık takip sürecinde radyasyon proktiti tanısı ile iki hasta APC yöntemi ile tedavi edilmiştir. İkihastanın da altta yatan hastalığı prostat kanseri idi ve radyasyon tedavisinin 12 ve 8. aylarındaproktit tablosu ortaya çıkmıştı. APC tedavisi 15er günlük intervaller halinde uygulandı. Her ikihasta da izlemlerinin beşinci ve altıncı aylarında APC tedavisiyle kür sağlandı. Sonuç olarak, APCtedavi protokolü, radyasyon proktitinde etkin ve güvenilir bir tedavi metodu olarak uygulanabilir.

The effectivity of argon plasma coagulation in the treatment of radiation proctitis

Proctitis may be a long term complication of radiation therapy for pelvic malignancies. The exacttreatment of radiation proctitis is controversial. Argon plasma coagulation (APC) is the mostacceptable therapy of radiation proctitis. In our clinic, two patients were included into the APCtherapy protocol in the last two years of follow-up. The underlying diseases of the patientsdiagnosed with radiation proctitis were prostate cancer and the radiation proctitis were seen 12 and8 months after cessation of radiation therapy. The APC therapy was perfomed at 15 days intervals.Both of the patients were free of symptoms at the end of the fifth and sixth months of follow upperiod. In conclusion, APC treatment seems to be effective and safe in radiation proctitis.

PDF

___

1. Cotti G, Seid V, Araujo S, Souza AH Jr, Kiss DR, Habr-Gama A. Conservative therapies for hemorrhagic radiation proctitis: a review. Rev Hosp Clin Fac Med Sao Paulo 2003; 58: 284-92.
2. Hayne D, Vaizey CJ, Boulos PB. Anorectal injury following pelvic radiotherapy. Br J Surg 2001; 88: 1037-48.
3. Kochhar R, Sriram PV, Sharma SC, Goel RC, Patel F. Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension. Dig Dis Sci 1999; 44: 973-8.
4. Haboubi NY, Schofield PF, Rowland PL. The light and electron microscopic features of early and late phase radiation-induced proctitis. Am J Gastroenterol 1988; 83: 1140-4.
5. Hong JJ, Park W, Ehrenpreis ED. Review article: current therapeutic options for radiation proctopathy. Aliment Pharmacol Ther 2001; 15: 1253-62.
6. Parikh S, Hughes C, Salvati EP, Eisenstat T, Oliver G, Chinn B, Notaro J. Treatment of hemorrhagic radiation proctitis with 4 percent formalin. Dis Colon Rectum 2003; 46: 596-600.
7. Zinicola R, Rutter MD, Falasco G, Brooker JC, Cennamo V, Contini S, Saunders BP. Haemorrhagic radiation proctitis: endoscopic severity may be useful to guide therapy. Int J Colorectal Dis 2003; 18: 439-44.
8. Isomoto H, Hazama H, Shikuwa S, Omagari K, Mizuta Y, Murase K, Murata I, Kohno S. A case of haemorrhagic radiation proctitis: successful treatment with argon plasma coagulation. Eur J Gastroenterol Hepatol 2002; 14: 901-4.
9. Kaassis M, Oberti E, Burtin P, Boyer J. Argon plasma coagulation for the treatment of hemorrhagic radiation proctitis. Endoscopy 2000; 32: 673-6.
10. Büyükberber M, Savaş MC, Gülşen MT, Koruk M, Kadayifçi A. Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis. Turk J Gastroenterol 2005; 16: 232-5.
11. Swan MP, Moore GT, Sievert W, Devonshire DA. Efficacy and safety of single- session argon plasma coagulation in the management of chronic radiation proctitis. Gastrointest Endosc 2010; 72: 150-4.
12. Ginsberg GG, Barkun AN, Bosco JJ, Burdick JS, Isenberg GA, Nakao NL, Petersen BT, Silverman WB, Slivka A, Kelsey PB; American Society for Gastrointestinal Endoscopy. The argon plasma coagulator: February 2002. Gastrointest Endosc 2002; 55: 807-10.
13. Ben-Soussan E, Antonietti M, Savoye G, Herve S, Ducrotté P, Lerebours E. Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis is efficient but requires a perfect colonic cleansing to be safe. Eur J Gastroenterol Hepatol 2004; 16: 1315-8.
14. Karamanolis G, Triantafyllou K, Tsiamoulos Z, Polymeros D, Kalli T, Misailidis N, Ladas SD. Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy 2009; 41: 529-31.
15. Seth AK, Kapoor N, Puri P. Colonic explosion with use of argon plasma coagulation for radiation proctitis. Indian J Gastroenterol 2009; 28: 118-9.
16. Baughan CA, Canney PA, Buchanan RB, Pickering RM. A randomized trial to assess the efficacy of 5-aminosalicylic acid for the prevention of radiation enteritis. Clin Oncol (R Coll Radiol) 1993; 5: 19-24.
17. Seo EH, Kim TO, Kim TG, Joo HR, Park J, Park SH, Yang SY, Moon YS, Park MJ, Ryu DY, Song GA. The efficacy of the combination therapy with oral and topical mesalazine for patients with the first episode of radiation proctitis. Dig Dis Sci 2011; 56: 2672-7.
18. Hernandez Sanchez A, Vicente Sanchez Mdel P, Arteta Jimenez M. Formalin for haemorrhagic radiation-induced proctitis. Int J Colorectal Dis 2012; 27: 683-5.