Nonendoscopic therapies for the management of radiation-induced rectal bleeding.

PURPOSE OF REVIEW

Rectal bleeding is one of several gastrointestinal side effects that occur after radiotherapy for pelvic malignancy. It can develop during treatment as a result of inflammation, or may be delayed for up to several years, where it is characteristically due to vascular neogenesis within ischaemic tissue. More patients with radiation-induced rectal bleeding are presenting to medical professionals as the number of cancer survivors continues to increase. This review outlines the nonendoscopic treatments that presently exist.

RECENT FINDINGS

Guidance was published on the management of gastrointestinal side effects of radiotherapy in 2012. Recent publications have assessed many agents for the treatment of rectal bleeding including antibiotics, colonic irrigation, formalin and ozone therapy. The 'HOT-II' randomized controlled trial of hyperbaric oxygen (HBO) therapy is keenly awaited.

SUMMARY

There is no consensus on the optimal management of radiation-induced rectal bleeding. Therapies with evidence of benefit from randomized trials (of variable quality) are sucralfate enemas, antibiotics, vitamin A and HBO therapy. Other nonendoscopic therapies exist; however, there is a paucity of evidence to recommend these at present. Well constructed, randomized controlled trials are required to compare and evaluate therapeutic options.