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Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon

2026, Number 1

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Rev Mex Coloproctol 2026; 22 (1)

Radiation induced proctitis: systematic review

Delgadillo X, Salgado G, Yanes B

Language: Spanish
References: 61
Page: 18-32
PDF size: 1811.16 Kb.


ABSTRACT

Introduction: radiation-induced proctitis is a common and often debilitating complication of pelvic radiotherapy, in patients treated for malignancies such as prostate, cervical, and rectal cancers. It manifests in acute or chronic forms, with symptoms ranging from mild discomfort to severe rectal bleeding, ulceration, fistulas and strictures, significantly impacting quality of life. Despite its prevalence, optimal strategies for prevention and management remain debated. Objective: this systematic review aims to evaluate the current evidence on the incidence, pathophysiology, clinical presentation, diagnostic approaches, and treatment modalities for radiation-induced proctitis, with an emphasis on recent advances and evidence-based interventions. Material and methods: a comprehensive literature search was conducted using databases including PubMed, Embase, and Cochrane Library up to March 2025. Studies included randomized controlled trials, cohort studies, and systematic reviews focusing on patients who developed proctitis following pelvic radiotherapy. Articles were screened for relevance and quality using PRISMA guidelines and assessed for risk of bias. Results: the review identified 80 studies that met the inclusion criteria. Acute proctitis typically occurs within three months of radiotherapy and is largely self-limiting, whereas chronic proctitis may present months to years later and requires more complex management. Therapeutic options include anti-inflammatory agents, sucralfate enemas, formalin application, hyperbaric oxygen therapy, and endoscopic interventions. Recent studies highlight promising roles for probiotics, mesalazine, and argon plasma coagulation. Preventive strategies, including intensitymodulated radiation therapy (IMRT) and rectal spacers, show efficacy in reducing incidence. Conclusions: radiation-induced proctitis remains a significant clinical challenge with a multifaceted pathogenesis and variable presentation. Emerging treatments and preventive techniques offer hope for improved patient outcomes. However, further high-quality, large-scale trials are needed to establish standardized, evidence-based protocols for both prevention and management.


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