The treatment of chronic radiation proctitis with hyperbaric oxygen in patients with prostate cancer

Therapeutic irradiation is commonly used to treat clinically localized prostate cancer. Although radiation therapy is effective for localized prostate cancer, the rectum is often affected because of its proximity to the treated tumour. The incidence of severe chronic radiation proctitis induced by pelvic irradiation is reported to be 2–5%. The symptoms of chronic radiation proctitis include diarrhoea, tenesmus, abdominal pain and rectal bleeding, and perforation, necrosis, stenosis and ulceration of the intestine may occur. The natural history of chronic radiation proctitis is unpredictable. While some patients with mild symptoms may experience remission, others suffer a progressively worsening course that can result in a life-threatening condition.

Chronic radiation proctitis is generally considered to be difficult to manage. Medical treatment with a low–residue diet and steroidal or nonsteroidal enemas has been disappointing. Laser therapy or electrocoagulation is often used to halt rectal bleeding. Although these attempts are initially successful in many patients, recurrence of bleeding is a common problem. Although faecal diversion is the most common operative procedure, this may not always control rectal bleeding and surgical resection of the involved segment may be necessary. Surgical complications are common, with a morbidity and mortality of 10–80%; thus an effective alternative treatment is required, particularly as medical treatment often fails. Hyperbaric oxygen therapy (HBOT) was recently reported to be safe and effective for the treatment of chronic radiation proctitis. We report the outcome of HBOT in four patients with chronic radiation proctitis.