Deng Y, Du ZM, Li HF, Tang FS. Thalidomide for refractory hemorrhagic chronic radiation proctitis: Bridging the gap between symptom control and disease-modifying therapy. World J Gastroenterol 2026; 32(38): 120289 [DOI: 10.3748/wjg.120289]
Corresponding Author of This Article
Fu-Shan Tang, PhD, Professor, Department of Clinical Pharmacy, Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, No. 6 Xuefu West Road, Xinpu New District, Zunyi 563006, Guizhou Province, China. fstang@vip.163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Deng Y, Du ZM, Li HF, Tang FS. Thalidomide for refractory hemorrhagic chronic radiation proctitis: Bridging the gap between symptom control and disease-modifying therapy. World J Gastroenterol 2026; 32(38): 120289 [DOI: 10.3748/wjg.120289]
World J Gastroenterol. Oct 14, 2026; 32(38): 120289 Published online Oct 14, 2026. doi: 10.3748/wjg.120289
Thalidomide for refractory hemorrhagic chronic radiation proctitis: Bridging the gap between symptom control and disease-modifying therapy
Ya Deng, Zhi-Min Du, Hong-Fang Li, Fu-Shan Tang
Ya Deng, Zhi-Min Du, Hong-Fang Li, Fu-Shan Tang, Department of Clinical Pharmacy, Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, Zunyi 563006, Guizhou Province, China
Ya Deng, Zhi-Min Du, Hong-Fang Li, Fu-Shan Tang, Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi 563006, Guizhou Province, China
Hong-Fang Li, Department of Pharmacy, Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi 563003, Guizhou Province, China
Author contributions: Deng Y drafted and revised the manuscript; Du ZM and Li HF provided discussion and literature support; Tang FS contributed to idea generation, revised the manuscript, and provided supervision. All authors reviewed and approved the final manuscript.
AI contribution statement: No AI tool was used to generate any part of the main text (Abstract, Introduction, Materials and Methods, Results, Discussion, or Conclusion). The conceptual framework, critical evaluation of Huang et al’s work, analysis of CRP pathophysiology, editorial viewpoints, and all references are entirely our own. However, as non-native English speakers, we used DeepL and ChatGPT only for language polishing and sentence-level revision to improve fluency.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Fu-Shan Tang, PhD, Professor, Department of Clinical Pharmacy, Key Laboratory of Basic Pharmacology of Guizhou Province and School of Pharmacy, Zunyi Medical University, No. 6 Xuefu West Road, Xinpu New District, Zunyi 563006, Guizhou Province, China. fstang@vip.163.com
Received: February 24, 2026 Revised: April 16, 2026 Accepted: May 22, 2026 Published online: October 14, 2026 Processing time: 196 Days and 15.6 Hours
Abstract
Hemorrhagic chronic radiation proctitis (CRP) represents a persistent and debilitating complication in survivors of pelvic radiotherapy, often leading to recurrent bleeding, chronic anemia, and diminished quality of life. As oncology shifts toward long-term survivorship care, effective management of CRP has emerged as a critical unmet need. A recent phase II trial demonstrated that low-dose thalidomide achieved an 83.9% clinical response rate in refractory hemorrhagic CRP, with a favorable safety profile, suggesting its potential as a systemic therapeutic option between local interventions and invasive surgery, pending further validation. Notably, the dissociation between symptomatic improvement and endoscopic findings underscores the importance of incorporating patient-reported outcomes alongside traditional objective metrics. Emerging evidence suggests that CRP pathophysiology involves sustained microvascular dysfunction, chronic inflammation, and possibly gut microbiome alterations-factors that may inform future targeted therapies. In this context, Huang et al recently published a study in World Journal of Gastroenterology, which reviews the pathogenesis, pathological features, and current treatment landscape of CRP. It then discusses the implications of thalidomide’s efficacy, highlights the study’s limitations (including its single-arm design and short follow-up), and considers the potential for a paradigm shift in CRP management: From reactive hemostasis to integrated, long-term strategies that address both symptoms and underlying disease mechanisms within a comprehensive survivorship care framework.
Core Tip: Low-dose thalidomide demonstrated an 83.9% clinical remission rate and favorable safety profile in refractory hemorrhagic chronic radiation proctitis (CRP) during a phase II trial, suggesting its potential as a systemic therapeutic option based on preliminary evidence. The observed discrepancy between symptom improvement and endoscopic findings underscores the necessity of including patient-reported outcomes alongside traditional objective metrics. This article reviews the pathogenesis and treatment options for CRP, interprets thalidomide’s clinical significance, evaluates the limitations of the study, and advocates for mechanism-based comprehensive management strategies during cancer survivorship.
