Formalin irrigation for hemorrhagic chronic radiation proctitis

Table 1 Vienna rectoscopy score of endoscopic findings for hemorrhagic chronic radiation proctitis

Score	Congested mucosa	Telangiectasia	Ulceration	Stricture	Necrosis
0	Focal reddening	None	None	None	None
1	Diffuse, nonconfluent	Single	None	None	None
2	Diffuse confluent	Multiple, nonconfluent	None	None	None
3	Any	Multiple, confluent	Micro-ulceration, superficial, < 1 cm2	None	None
4	Any	Any	Superficial, > 1 cm2	> 2/3 regular diameter	None
5	Any	Any	Deep ulceration, fistula, perforation	≤ 2/3 regular diameter	Any

The highest grade of any one parameter qualifies for the attribution to one of the given score levels regardless of the grade achieved in any other parameter.

Table 2 Patient demographics n (%)

Characteristic	Value
Age, yr	61.5 ± 9.5
Sex, female/male	19/5
Primary cancer
Cervical	15 (62.5)
Endometrium	3 (12.5)
Prostatic	3 (12.5)
Rectal	2 (8.3)
Cervical and ovarian	1 (4.2)
Total irradiation dosage1, Gy	75 (44-97)
Concomitant chemotherapy	13 (54.2)
History of abdominopelvic operation	13 (54.2)
History of acute radiation proctitis	19 (79.2)
Time from the end of radiotherapy to bleeding, mo	11.1 ± 9.0
Duration of bleeding, mo	10.6 ± 8.0
Grade of bleeding, CTCAE v 3.0
II	20 (83.3)
III	4 (16.7)
Preoperative hemoglobin, g/L	107.6 ± 16.4
Transfusion dependent	6 (25.0)
Preoperative VRS	3 (1-5)

¹Data from 15 patients (9 received radiotherapy in other centers). VRS: Vienna rectoscopy score.

Table 3 Demographic and clinical parameters of three patients with rectal fistulas after topical formalin irrigation

Parameter	Case 1	Case 2	Case 3
Preoperative VRS score	5	5	4
Preoperative ulcer score	3	2	2
Formalin concentration	4%	4%	4%
Time of formalin exposure	30 s	1 min	2 min
Courses of formalin irrigation	1	1	1
Postoperative VRS score	Unknown	5	5
Time from the end of radiotherapy to fistula formation, mo	3	20	1
Therapy for rectal fistula	Diversion	Parks operation	Parks operation

VRS: Vienna rectoscopy score.

Table 4 Univariate analysis of endoscopic findings after topical formalin irrigation

Variable	With fistula	Without fistula	P value1
VRS scores	5 (4-5)	3 (1-5)	0.012
Friable mucosa	1 (0-1)	1 (0-3)	0.374
Telangiectasis	2 (1-2)	2 (1-3)	0.231
Ulcer	0 (0-5)	4 (0-5)	0.022
Necrosis	0 (0-5)	0 (0-5)	0.556

¹Wilcoxon rank sum test; data are presented as median (range).