A simple and effective treatment for hemorrhagic radiation proctitis using formalin

Abstract

Radiation proctitis is a common complication of radiotherapy for pelvic malignancy. In the more severe form, it leads to intractable or massive hemorrhage, which may require repeated hospital admissions and blood transfusions. Medical therapy in patients with radiation proctitis is usually ineffective, whereas surgery is associated with a high morbidity and mortality. Eight patients (seven females and one male) with hemorrhagic radiation proctitis were treated over a six-month period with endoluminal formalin. The technique used ensured minimal contact with formalin. The median age of the patients was 68 years (range, 42-73 years). Seven patients had had cancer of the uterine cervix, and one patient had had cancer of the prostate treated with radiotherapy at a median time of 30 months (range, 9-46 months) previously. The median duration of time of symptomatic rectal hemorrhage before formalin therapy was eight months (range, 1-12 months). The median number of units of blood transfused previously per patient was four (range, 2-32). The time taken for formalin therapy was 20 minutes (range, 10-70 minutes). One patient required repeat formalin application at two weeks. Bleeding ceased immediately in seven patients after formalin treatment. No further bleeding was noted, nor was any blood transfusion needed, at follow-up at four months (range, 1-6 months). Formalin therapy is a simple, inexpensive, and effective treatment for hemorrhagic radiation proctitis.

Pelvic radiation disease: Updates on treatment options

“…Standard gauze pledgets soaked in 4% formalin solution have to be applied to the affected areas under direct vision, starting proximally. Each pledget needs to be held in place for 1 min for each affected area until all areas distally had been treated [61,64] . Endoscopic application of formalin is more frequently associated with complications and requires more skilled endoscopists than argon plasma coagulation therapy [65] .…”

Late rectal complications after prostate brachytherapy for localized prostate cancer

“…11,64 In several small, nonrandomized studies, the short-term success rate of this technique ranged from 60% to 100%. [66][67][68][69][70][71][72][73] The documented complications, including perianal ulcerations and fissures, anal stenosis, and fecal incontinence, occurred in 27% of patients.…”

Instilação de formalina endoluminal como opção terapêutica da retite actínica hemorrágica

“…a solução de formalina pode ser aplicada no reto basicamente de duas maneiras: por irrigação, quer de solução de formalina a 3,6 25 , 4 1,3,12,16,21,26 ou 5% 17 ; e uma outra técni-ca, proposta por Seow-choen et al 27 , é a aplicação direta com gaze embebida em formol, seja com solução a 4 1,4,6,[9][10][11][12]15,16,18,20,[26][27][28][29][30][31][32] ou 10% 2 . no presente trabalho, o controle da hemorragia foi atingido com a instilação endoluminal de formalina a 4 e 2%.…”

“…independente do método utilizado, a maioria dos autores recomenda a lavagem do reto com solução salina após a aplicação da formalina 5,11,23 . Para a proteção do períneo, podem ser aplicadas várias camadas de pomada protetoras antes do procedimento 11,12,15,16,27 , ou ainda um cateter de Foley pode ser introduzido e insuflado no reto para evitar qualquer fuga de formalina à mucosa anal e ao períneo 3,5,23 . além disto, uma gaze pode ser colocada acima da margem de sangramento a fim de proteger a mucosa saudável 3 .…”

“…Quando em contato com a mucosa, essa substância produz cauterização química local, determinando esclerose dos vasos com consequente melhora do sangramento 6,8,11,14 . após esse trabalho, surgiram várias publicações [1][2][3][4]6,9,[10][11][12][15][16][17][18][20][21][22][23][24][26][27][28][29][30][31][32] , em que os autores vêm tentando determinar a melhor técnica de aplicação, a concentração mais eficaz e identificar as complicações relacionadas com a sua aplicação. na Tabela 1, foram agrupadas, de forma comparativa, as diferentes séries de casos.…”