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O3 Hemorrhagic Radiation Proctitis

Abstract

Context. Persistent or severe hemorrhagic radiation proctitis (HRP) has limited therapeutic options.

Objectives. To describe our experience with ozone therapy (O3T) in the management of refractory HRP.

Methods. Patients (n 1⁄4 17; median age 69 years [range 42e80 years]) previously irradiated for prostate or uterine cancer and suffering persistent or severe HRP without response to conventional treatment were enrolled to receive an O3/O2 gas mixture via rectal insufflations and topical application of ozonized oil. Most of the patients (83%) had Grade 3 or Grade 4 toxicity. Median follow-up post-O3T was 40 months (range 3e56 months).

Results. Endoscopic treatments required were 43 (median 1; range 0e10) pre- O3T, 17 (median 0; range 0e8; P 1⁄4 0.063) during O3T, and five (median 0; range 0e2; P 1⁄4 0.008) during follow-up. Hemoglobin levels were 10.35 g/dL
(7e14 g/dL) pre-O3T and 13 g/dL (9e15 g/dL) (P 1⁄4 0.001) post-O3T. Median toxicity grades were 3 (range 2e4) pre-O3T, 1 (range 0e2; P < 0.001) at the end of O3T, and 0 (range 0e1; P < 0.001) at the last follow-up.

Conclusion. Persistent advanced HRP was significantly improved with O3T. The addition of O3T can be useful as a complementary treatment in the long-term.

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