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 O 3/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-O 3T, 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 O 3T can be useful as a complementary treatment in the long-term management of HRP and, as such, merits further evaluation. © 2013 U.S. Cancer Pain Relief Committee.Published by Elsevier Inc. All rights reserved.