Published online Aug 14, 2013. doi: 10.3748/wjg.v19.i30.4944
Revised: April 19, 2013
Accepted: May 7, 2013
Published online: August 14, 2013
AIM: To evaluate the results of hemorrhagic radiation proctopathy treatment with a 4% formalin application.
METHODS: A prospective study was performed. Over a three-year period, 38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy. All patients included in the study were irradiated for prostate cancer. The patients ranged in age from 56-77 years (average 70 ± 5 years). All of the patients were referred for formalin therapy after noninvasive management had failed. Twenty-four (63.2%) patients underwent a single application, 10 (26.3%) patients underwent 2 applications, and 4 (10.5%) patients underwent 3 applications.
RESULTS: Two to 36 mo (average 12 ± 3 mo) following treatment, 34 patients were interviewed (four were lost to follow-up). Twenty (58.8%) subjects reported complete cure, 8 (23.5%) subjects reported significant improvement, and 6 (17.7%) subjects reported no change. One patient (who underwent a colostomy at a regional hospital with no specialized services available for previous bleeding episodes from radiation proctopathy) was cured, and the colostomy was closed. One patient (2.6%) developed rectal mucosal damage after the second application.
CONCLUSION: A 4-min application of 4% formalin for hemorrhagic radiation-induced proctopathy under perianal anesthetic infiltration in patients who have received external radial radiation therapy for prostate cancer is simple, reasonably safe, inexpensive, generally well tolerated, and effective.
Core tip: In a prospective study conducted from 2006 to 2009, 38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy. Based on the rectal-telangiectasia density classification, eight (21.1%) patients had grade I proctitis, 23 (60.5%) patients had grade II proctitis, and seven (18.4%) patients had grade III proctitis. A piece of gauze soaked with 4% formalin was applied to the entire diseased rectal mucosa and remained for 4 min under perianal anesthetic infiltration. Twenty patients (58.8%) reported complete cure, eight patients (23.5%) reported significant improvement, and six patients (17.7%) reported no change. Application of 4% formalin under perianal anesthetic infiltration in patients who received external radial radiation therapy for prostate cancer was simple, safe, and effective.