Long-term control of refractory hemorrhagic radiation proctitis with ozone therapy

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 = 17; median age 69 years [range 42–80 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 3–56 months). Results

Endoscopic treatments required were: 43 (median 1; range 0–10) pre-O3T; 17 (median 0; range 0–8; P = 0.063) during O3T; and five (median 0; range 0–2; P = 0.008) during follow-up. Hemoglobin levels were 10.35 g/dL (7–14 g/dL) pre-O3T and 13 g/dL (9–15 g/dL) (P = 0.001) post-O3T. Median toxicity grades were 3 (range 2–4) pre-O3T, 1 (range 0–2; P < 0.001) at the end of O3T, and 0 (range 0–1; 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 management of HRP and, as such, merits further evaluation.