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Henry V Chung, Alan A Weiss

Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia

BACKGROUND: Radiation proctitis is a recognized complication of radiotherapy to the pelvis due to the relatively fixed position of the rectum within the administered field of pelvic radiation. The KTP (potassium titanyl phosphate) laser is a Nd/YAG-driven unit that uses light with a wavelength of 532 nm. This energy is absorbed by hemoglobin and penetrates to a depth of 1 to 2 mm. The purpose of this study was to study the therapeutic results of the KTP laser.

METHODS: All the patients treated with the KTP laser for the chronic bleeding secondary to radiation proctitis were assessed from 1997 to 2002. Bleeding magnitude and frequency were assessed and graded on a 5-point scale with a mean follow-up of 17 months.

RESULTS: KTP laser was used in 52 patients with a mean age of 69 years (range 41 to 82 years). 38 men were treated for prostate cancer, 14 women were treated for gynecological malignancies (6 endometrial, 5 cervical and 3 vaginal cancer). The mean external beam dose was 5839 cGy(4839-7200cGy) in 50 patients, 12 also received intracavitary insertion with an average of 2107cGy(530-2700cGy), 2 patients received I125 brachytherapy direct to the prostate. An average of 2.4 treatments was required with an average follow up of 17.1 months (range 1 to 65 months). 31 (59.6%) patients had complete cessation of bleeding, 15 (28.8%) had significant improvement in their symptoms, 5 (9.6%) failed treatment and 1 (2%) underwent hemicolectomy secondary to a radiation induced rectal ulcer. Mean time to symptoms was 9.6 months post radiotherapy (range 0–43 months). The treatments were well tolerated and there were no complications.

CONCLUSION: This is the first Canadian study that has assessed the use of KTP laser in treating radiation proctitis. KTP laser is a safe and effective treatment for rectal bleeding from radiation proctitis.

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