COMPARISON OF ARGON PLASMA COAGULATION AND FORMALIN INSTILLATION IN THE TREATMENT OF RADIATION INDUCED HAEMORRHAGIC PROCTOCOLITIS

Background: Radiotherapy is routinely used in the treatment of pelvic malignancies and about 2-5% of these patients develop radiation induced proctitis or proctocolitis. This complication of radiotherapy is treated in different ways. Two of these treatments, argon plasma coagulation (APC) and formalin instillation, have both been reported as to be successful modalities, but data comparing them are scarce. We conducted this study to compare these two treatment options.  Methods: We reviewed the charts of patients who had radiation-induced proctocolitis and who were treated endoscopically at our tertiary-care cancer centre with either APC or formalin instillation. Outcomes of the two treatments were compared in terms of bleeding control after the first session of treatment, the number of sessions required and the final response to therapy.  Results: Out of a total of 26 patients presenting with hemorrhagic radiation proctocolitis, 11 were treated with APC and 15 with formalin instillation. Success after the first session was 53% in the formalin instillation group compared to 18% in the APC-treated group. On repeated sessions, the final response to both treatment modalities was comparable.  Conclusion: Efficacy of APC and formalin instillation in the treatment of hemorrhagic radiation proctocolitis is comparable although formalin showed a better outcome after the first session.