Argon plasma: therapeutic response and quality of life in patients with radiation proctitis
Keywords:
Radiation proctitis, rectal bleeding, argon plasma coagulation, therapeutic response, endoscopic therapy, recurrence, quality of life.Abstract
Introduction: Chronic hemorrhagic radiation proctitis (CHRP) appears secondary to pelvic radiotherapy. Argon plasma coagulation (APC) is an effective, safe, easy-to-use, and relatively inexpensive therapy.
Objective: To describe the short- and long-term therapeutic response of APC in patients with CHRP, as well as to evaluate the quality of life before and after the intervention.
Material and Methods: Observational, prospective case series study of 46 patients with CHRP, treated at the National Center for Minimally Access Surgery between 2017 and 2020. Summary measures and comparison of means (paired Student's t-test) were used for baseline and final hemoglobin, as well as for the quality of life scores applied before and after the intervention. The Kaplan-Meier method was used to determine the recurrence free time. A level of significance less than 0.05 was estimated for a 95 % confidence interval.
Results: A mean of 3,6 ± 2,394 APC sessions was required. The mean hemoglobin increased 1,9 g / L. Short-term therapeutic response was observed in 100 % of patients, and long-term in 91,3 %. The mean score for quality of life decreased by 12,065 points (p˂ 0,00). The perceived global perception increased by a mean of 7,326 points (p˂ 0,00).
Conclusions: APC has a good therapeutic response in the short and long term with few sessions and a low number of complications, with an improvement in the quality of life of the patients.
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References
1. Organización Mundial de la Salud. Estadísticas Sanitarias Mundiales 2020: monitoreando la salud para los ODS, objetivo de desarrollo sostenible [Internet]. Ginebra: Organización Mundial de la Salud; 2020 [Citado 04/11/2020]. Disponible en: https://apps.who.int/iris/Estadísticas-Sanitarias-Mundiales-2020
2. Ministerio de Salud Pública. Anuario Estadístico de Cuba 2020 [Internet]. La Habana: MINSAP; 2021 [Citado 04/11/2020]. Disponible en: http://bvscuba.sld.cu/anuario-estadistico-de-cuba/2020
3. Lee JK, Agrawal D, Thosani N, Al Haddad M, Buxbaum JL, Calderwood AH, et al. ASGE guideline on the role of endoscopy for bleeding from chronic radiation proctopathy. Gastrointest Endosc [Internet]. 2019 [Citado 01/01/2021];19:1-12. Disponible en: https://www.giejournal.org/article/S0016-5107(19)31661-X/fulltext
4. Peng Y, Wang H, Feng J. Efficacy and Safety of Argon Plasma Coagulation for Hemorrhagic Chronic Radiation Proctopathy: A Systematic Review. Gastroenterology Research and Practice [Internet]. 2018;2018:[Aprox. 2 p.]. Disponible en: https://doi.org/10.1155/2018/3087603
5. Tabaja L, Sidani SM. Management of radiation proctitis. Dig Dis Sci [Internet]. 2018;63(9):2180-8. Disponible en: https://doi.org/10.1007/s10620-018-5163-8
6. Lee J, Han HJ, Min BS, Hong SP, Shin SJ, Yoon HI. The role of endoscopic evaluation for radiation proctitis in patients receiving intermediate-dose postoperative radiotherapy for rectal cancer. Jpn J Clin Oncol [Internet]. 2018;48:1-7. Disponible en: https://doi.org/10.1093/jjco/hyy126
7. Weiner JP, Wong AT, Schwartz D, Martínez M, Aytaman A, Schreiber D. Endoscopic and non¬endoscopic approaches for the management of radiation-induced rectal bleeding. World J Gastroenterol [Internet]. 2016;22(31):6972¬86. Disponible en:: http://dx.doi.org/10.3748/wjg.v22.i31.6972
8. Wu C, Guan L, Yao L, Huang J. Mesalazine suppository for the treatment of refractory ulcerative chronic radiation proctitis. Exp Ther Med [Internet]. 2018;16(3):2319-24. Disponible en: https://doi.org/10.3892/etm.2018.6464
9. Li YD, Xu JH, Lin JJ, Zhu WF. Application of 4 % formaldehyde under electronic colonoscope as a minimally invasive treatment of chronic hemorrhagic radiation proctitis. World J Emerg Med [Internet]. 2019;10(4):228-31. Disponible en: https://doi.org/10.5847/wjem.j.1920-8642.2019.04.006
10. Alpuim Costa D, Amaro CE, Nunes A, Cardoso JS, Daniel PM, Branco JV, et al. Hyperbaric oxygen therapy as a complementary treatment for radiation proctitis: Useless or useful? - A literature review. World J Gastroenterol [Internet]. 2021;27(27):4413-28. Disponible en: https://doi.org/10.3748/wjg.v27.i27.4413
11. Lenz L, Rohr R, Nakao F. Chronic radiation proctopathy: A practical review of endoscopic treatment. World J Gastrointest Surg [Internet]. 2016 [Citado 04/11/2020];8(2):151-60. Disponible en: https://www.wjgnet.com/1948-9366/full/v8/i2/151.htm
12. Martínez López R, Díaz Canel Fernández O, Ruiz Torres J. Tratamiento de la proctitis actinica con argon plasma. Primera experiencia en Cuba. Rev haban cienc méd [Internet]. 2008 [Citado 04/11/2020];7(1):[Aprox. 2 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1729-519X2008000100020
13. Montes de Oca Megías E, Morera Pérez M, Pedroso Noa G. Endoscopic Therapy with Argon Plasma for Radiation Proctitis: Factors Associated to the Number of Therapeutic Sessions. Gastroenterol Hepatol Open Access [Internet]. 2017 [Citado 04/11/2020];8(2):00276. Disponible en: https://medcraveonline.com/GHOA/GHOA-08-00276.php
14. Chutkan R, Lipp J, Waye J. The argon plasma coagulator: a new and effective modality for the treatment of radiation proctitis. Gastrointest Endosc [Internet]. 1997;45(4):AB27. Disponible en:, http://dx.doi.org/10.1016/S0016-5107(97)80012-0
15. Zinicola R, Rutter MD, Felasco G. Hemorrhagic radiation proctitis: endoscopic severity may be useful it guide therapy. Int J Colorectal Dis [Internet]. 2003 [Citado 06/10/2020];18:439-44. Disponible en: https://link.springer.com/article/10.1007%2Fs00384-003-0487-y
16. Fayers P, Aaronson N, Bjordal K, Grønvold M, Curran D, Bottomley A. EORTC. Manual de puntuación QLQ-C30. Bruselas: Organización Europea de Investigación y Tratamiento del Cáncer; 2001.
17. Weiner J, Schwartz D, Martinez M. Long-term results on the efficacy of argon plasma coagulation for patients with chronic radiation proctopathy after conventionally fractionated, dose-escalated radiation therapy for prostate cancer. Pract Radiat Oncol [Internet]. 2017;7(1):e35-e42. Disponible en: https://doi.org/10.1016/j.prro.2016.07.009
18. Sebastian S, O'Connor H, O'Morain C. Argon plasma coagulation as first-line treatment for chronic radiation proctopathy. Journal of Gastroenterology and Hepatology [Internet]. 2004 [Citado 06/10/2020];19(10):1169-73. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1746.2004.03448.x
19. Siow SL, Mahendran HA, Seo CJ. Complication and remission rates after endoscopic argon plasma coagulation in the treatment of haemorrhagic radiation proctitis. Int J Colorectal Dis [Internet]. 2017;32(1):131-4. Disponible en: https://doi.org/10.1007/s00384-016-2635-1
20. Zhong QH, Liu ZZ, Yuan ZX, Ma TH, Huang XY, Wang HM, et al. Efficacy and complications of argon plasma coagulation for hemorrhagic chronic radiation proctitis. World J Gastroenterol [Internet]. 2019;25(13):1618-27. Disponible en: https://doi.org/10.3748/wjg.v25.i13.1618
21. Latorre Sánchez M, Sempere García-Argüelles J, Barceló Cerdá S. Valoración de la respuesta endoscópica al tratamiento con argón plasma en la rectitis actínica crónica. Rev Esp Enferm Dig [Internet]. 2008 [Citado 06/10/2020];100(10):619-24. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082008001000004
22. Hortelano E, Gómez Iturriaga A, Ortiz de Zarate R. Is argon plasma coagulation an elective and safe treatment option for patients with chronic radiation proctitis after high doses of radiotherapy?. Revista Española de Enfermedades Digestivas [Internet]. 2014 [Citado 06/10/2020];(3):165-70. Disponible en: http://www.grupoaran.com/mrmUpdate/lecturaPDFfromXML.asp?IdArt=4620880&TO=RVN&Eng=1
23. Karamanolis G, Triantafyllou K, Tsiamoulos Z. Argon plasma coagulation has a long-lasting therapeutic efect in patients with chronic radiation proctitis. Endoscopy [Internet]. 2009 [Citado 06/10/2020];41(6):529-53. Disponible en: https://doi.org/10.1055/s-0029-1214726
24. Kwan V, Bourke MJ, Williams SJ, Gillespie PE, Murray MA, Kaffes AJ, et al. Argon plasma coagulation in the management of symptomatic gastrointestinal vascular lesions: experience in 100 consecutive patients with long-term follow-up. Am J Gastroenterol [Internet]. 2006;101:58-63. Disponible en: https://doi.org/10.1111/j.1572-0241.2006.00370.x
25. Sultania S, Sarkar R, Das K, Dhali GK. Argon plasma coagulation is an effective treatment for chronic radiation proctitis in gynaecological malignancy: an observational study. Colorectal Dis [Internet]. 2019;21(4):465-71. Disponible en: https://doi.org/10.1111/codi.14541
26. Tjandra JJ, Sengupta S. Argon plasma coagulation is an efective treatment for refractory hemorrhagic radiation proctitis. Diseases of the Colon & Rectum [Internet]. 2001 [Citado 06/10/2020];44(12):1759-65. Disponible en: https://pdfs.semanticscholar.org/8569/d26f14715aeec6fb8e587bfe07caa33843fd.pdf
27. Villavicencio RT, Rex DK, Rahmani E. Eficacy and complications of argon plasma coagulation for hematochezia related to radiation proctopathy. Gastrointestinal Endoscopy [Internet]. 2002 [Citado 06/10/2020];55(1):70-4. Disponible en: https://doi.org/10.1067/mge.2002.119877
28. Paquette IM, Vogel JD, Abbas MA, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Chronic Radiation Proctitis. Dis Colon Rectum [Internet]. 2018;61:1135-40. Disponible en: https://doi.org/10.1097/DCR.0000000000001209
29. Spry N, Halkett G, Aoun S, Spry J, Yeoh E. Development of an EORTC module to assess the quality of life of patients with proctitis following pelvic radiotherapy for malignancy. International Journal of Radiation Oncology, Biology and Physics [Internet]. 2008;72(2):522-8. Disponible en: https://doi.org/10.1016/j.ijrobp.2007.12.062
30. Halkett G, Aouna S, Hayneb D, Lundc JA, Gruend A, Villa J, et al. EORTC radiation proctitis-specific quality of life module – Pretesting in four European countries. Radiother Oncol [Internet]. 2010;97:[Aprox. 2 p.]. Disponible en: https://doi.org/10.1016/j.radonc.2010.04.001
31. Halkett GB, Wigley CA, Aoun SM, Portaluri M, Tramacere F, Livi L, et al. International validation of the EORTC QLQPRT20 module for assessment of quality of life symptoms relating to radiation proctitis: a phase IV study. Radiation Oncology [Internet]. 2018;13:162. Disponible en: https://doi.org/10.1186/s13014-018-1107-x
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