Risk factors of bleeding ulceration after argon plasma coagulation in patients with radiation-associated vascular...

Argon plasma coagulation (APC) is an effective treatment for radiation-associated vascular ectasias (RAVE), but nonhealing ulceration with bleeding can occur after APC. However, the risk factors for bleeding ulceration remain poorly understood. This study aimed to identify the risk factors for bleeding ulceration after APC.

We conducted a retrospective analysis using prospectively collected data. Patients who underwent pelvic radiation and APC for RAVE at our hospital between January 2017 and December 2021 were included. Rectal dose-volume parameters were quantified using the equivalent dose in 2-Gy fractions (EQD2), with D0.5 cc, D1cc, D2cc, D5cc, and D10 cc representing the minimum dose received by the highest irradiated volumes of rectal tissue.

Of the 77 patients included, 6 (7.8%) developed bleeding ulceration after APC. Compared with patients without bleeding ulceration, those with bleeding ulceration had significantly greater Vienna Rectoscopy Scores (P = .005), median rectal EQD2 D10 cc (75.2 vs 61.7 Gy, P =.02), lower therapeutic success (50% vs 99%, P = .001), and lower improvement in hemoglobin levels (50% vs 89%, P = .035). Rectal EQD2 D10 cc had the greatest area under the curve of 0.79. The optimal cut-off point of rectal EQD2 D10 cc for predicting bleeding ulceration was 70 Gy. Multivariate analysis showed that rectal EQD2 D10 cc ≥70 Gy was associated with bleeding ulceration after APC.

Rectal EQD2 D10 cc ≥70 Gy is an independent risk factor for bleeding ulceration after APC for RAVE. In multidisciplinary management involving therapeutic radiologists, endoscopists may consider nonablative treatment instead of APC in patients with rectal EQD2 D10 cc ≥70 Gy.