Letter to the Editor: From hemostasis to healing – rethinking the therapeutic paradigm for chronic radiation proctitis

Abstract

Chronic radiation proctitis (CRP) is a complication of pelvic radiotherapy. Its pathogenesis is driven by microvascular injury, which leads to chronic ischaemia, inflammation, and progressive fibrosis. A recent phase II clinical trial by Huang et al, published in the recent issue of the World Journal of Gastroenterology, showed that thalidomide may reduce bleeding in patients with CRP by controlling local inflammation, inducing vasoconstriction, or improving coagulation, although its immediate effect on structural lesion repair appeared less pronounced. We propose integrating thalidomide with microbiota-based therapy, including fecal microbiota transplantation and washed microbiota transplantation, as a complementary therapeutic strategy that may promote intestinal microbial restoration and mucosal recovery in patients with CRP.

Keywords: Chronic radiation proctitis; Microbiota transplantation; Mucosal healing; Thalidomide; Combination therapy

Core Tip: Thalidomide can effectively reduce bleeding in patients with chronic radiation proctitis, but improvement in mucosal structure appears less pronounced. Microbiota-based therapy, including fecal microbiota transplantation and washed microbiota transplantation, may complement thalidomide by restoring the intestinal microbial ecosystem and promoting mucosal recovery. Integrating haemostatic treatment with microbiota-based therapy may shift the therapeutic goal for chronic radiation proctitis from bleeding control toward mucosal healing.