Background: One frequent sequela after radiotherapy for pelvic cancer is radiation proctocolitis. Bleeding is a common clinical presentation, with a wide range of severity. Radiation causes DNA, protein and lipid damage leading to mucosal friability and neovascular telangiectasias. The present study compared the results of local management of radiation-induced proctocolitis and evaluated factors related to failure under colonoscopy of sucralfate instillation and Argon plasma coagulator (APC).

Objective: To compare results of treatment of radiation proctitis with sucralfate to outcomes with APC.

Materials and Methods: The study was conducted from 2012 to 2016. Inclusion criteria were patients who were: (1) diagnosed with radiation proctocolitis from clinical examination with colonoscopy and pathology; and (2) aged from 18 to 80 years. Exclusion criteria were patients who: (1) Refused to undergo treatment; (2) had severe co-morbidities; or (3) were lost to follow-up. The patients were randomized into 2 groups, and data was collected regarding patient demographics; previous cancer disease; onset of clinical bleeding per rectum after last radiotherapy session, and hematocrit level before and during treatment.

Results: Of the 130 patients, 54 were randomised into the sucralfate group and the other 76 into the APC group. The mean age of the sucralfate group was 62.15+10.00 compared with 62.27+8.07 in the APC group. Time to presentation after last radiotherapy session were 7.16+4.97 and 6.15+4.18 years (p = 0.447), the first hematocrit before treatment were 34.86+4.61 and 32.17+6.52 (p = 0.010), and the failure rate in treatment in the sucralfate and APC groups were 5.6% and 15.8% (p = 0.096) respectively. The factors related to failure in both treatments were age >60 years, Hct at presentation <30 mg %, need blood transfusion, extension of disease above rectum, high rectal telangiectasia distribution grade, full circumferential involvement, and ulceration.

Conclusion: Sucralfate instillation for treatment of radiation proctocolitis is not inferior to APC. The factors related to failure in management were severity and extension of disease.

Keywords: Radiation proctitis, APC, Sucralfate, Colonoscopy