Clinical Features and Management of Acute and Chronic Radiation-Induced Colitis and Proctopathy

Area of Science:

• Gastroenterology
• Oncology
• Radiation Oncology

Background:

• Radiation-induced colitis and proctopathy (RICAP) is a common adverse effect of radiation therapy impacting patient quality of life.
• Limited data exists on the clinical characteristics and outcomes of RICAP.
• This study focuses on acute radiation-induced colitis and proctopathy (ARICAP) and chronic radiation-induced colitis and proctopathy (CRICAP).

Purpose of the Study:

• To analyze the clinical and endoscopic characteristics of ARICAP and CRICAP.
• To differentiate ARICAP and CRICAP based on symptom onset after radiation therapy (RT).
• To associate clinical variables with endoscopic and medical outcomes in RICAP patients.

Main Methods:

• Retrospective observational study at a single tertiary cancer center (2010-2018).
• Inclusion of 112 cancer patients with endoscopically confirmed ARICAP and CRICAP.
• Univariate and multivariate logistic regression analyses were performed.

Main Results:

• 46% of patients had ARICAP (predominantly non-bloody diarrhea), 55% had CRICAP (mostly bloody diarrhea).
• Neovascularization and bleeding were the most frequent endoscopic findings.
• ARICAP patients more often received medical management; CRICAP patients with bleeding more often received argon plasma coagulation (APC), though APC did not significantly reduce bleeding recurrence.

Conclusions:

• ARICAP and CRICAP exhibit distinct clinical and endoscopic features.
• Medical management should be prioritized over endoscopic therapy for RICAP.
• Argon plasma coagulation may be beneficial for patients with endoscopically visible bleeding.