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Abstract
Introduction. Radiation therapy (RT) is widely employed in the treatment of prostate cancer (PCa). However, a subset of patients experience radiation-induced complications in adjacent organs, including late radiation cystitis, urethritis, and proctitis, which significantly impair quality of life. While 4–10 % formalin coagulation is internationally used for the management of late radiation hemorrhagic proctitis (LRP), this approach carries a risk of severe complications. To mitigate these risks, we reduced the formalin concentration to 2.5 % and evaluated its efficacy in combination with comprehensive conservative therapy.
Aim. To evaluate the efficacy of reduced-concentration (2.5 %) formalin coagulation combined with comprehensive conservative therapy.
Materials and Methods. The study included 76 patients with cT1-3N0M0 prostate cancer who were treated for grade III LRP between 2009 and 2016. Patient age ranged from 53 to 82 years (median: 70 years). All patients had previously undergone combined hormone-radiation therapy at other Russian institutions, including external beam radiotherapy (n = 56), brachytherapy (n = 11), or combined radiotherapy (n = 9). LRP management consisted of comprehensive conservative therapy involving systemic medications and topical applications (microenemas, suppositories, sponges, and tubes) administered in four annual courses over one year. Additionally, 37 patients with inadequate response to conservative therapy underwent single-session chemical coagulation with 2.5% formalin (CCF). Treatment efficacy was evaluated at 6 and 12 months based on changes in radiation injury severity according to RTOG/EORTC criteria and endoscopic findings, comparing patients without CCF (Group I) and those receiving CCF (Group II).
Results. At the 6-month follow-up, therapeutic efficacy was 62 % in Group I and 89 % in Group II (p < 0.01), with complete or near-complete response (grade 0–I) achieved in 15 and 24 % of patients, respectively. By the 12-month assessment, efficacy rates reached 95 and 100 %, respectively, with Group II demonstrating significantly higher rates of complete/near-complete response (97 vs. 59 %). Surgical intervention was required in 2 patients (5%) from Group I and in none from Group II. No complications related to 2.5 % CCF or recurrence of bleeding were observed.
Conclusion. The addition of 2.5 % CCF to comprehensive conservative therapy improves treatment outcomes for grade III LRP without increasing complication rates when patients are appropriately selected.
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