Guidelines for Complications of Cancer Treatment Vol VIII Part B

complication rate of late rectal toxicity is nearly 65 Gy and 78Gy, respectively.Diagnosis, prevention and managementThe assemblage of symptoms contributing to late proctitis wasalluded to as long as 15 years ago and the RTOG definedproctitis as “being characterized by rectal irritation or urgency(tenesmus), presence of mucous or blood in the stool and, insome patients frequent loose bowel actions. More recently,the LENT/SOMA (Late Effect on Normal Tissues/ SubjectiveObjective Management Assessment) scoring system for lateradiation injuries has been introduced which lists six differentsymptoms of proctitis.A patient presenting to the clinic must be questioned aboutthe presence and severity of various gastrointestinal symptomsas stated above. Clinician must distinguish tenesmus fromdetecation frequency.A rectal examination with assessment of the sphincteric tone,proctoscopy and sigmoidoscopy is necessary. Counseling is ahelpful tool as majority patients may be reassured if they areeducated that they will get intermittent bleeding (particularlywhen they are constipated which should be avoided at all costs),that bleeding will subside over years.Kocchar et al., documented the benefit of sucralfate in delayedradiation proctitis. They stated that sucralfate enemas beingbetter tolerated and cheaper rendering a better clinical responseshould be the considered for short-term treatment for chronicproctitis. Other studies have shown that sucralfate is ineffectivein cases of acute radiation proctitis.A Cochrane review has summarised the evidence for treatmentof rectal bleeding from radiotherapy. Sucralfate enemas(2 g sucralfate suspension made-up with 30–50 mL water in abladder syringe injected twice a day via a lubricated foley269