Guidelines for Complications of Cancer Treatment Vol VIII Part B

catheter passed through the anus into the rectum) are moreeffective than corticosteroid or mesalazine enemas. Variousendoscopic treatment options exist: use of argon plasmacoagulation (APC), laser therapy, or formalin applied toaffected mucosa. In our institute, APC is widely practicedthough strongly contraindicated in case of rectal ulcers asperforation rates are high as reported in literature. Formalin isknown to decrease mucosal blood flow and can be used intwo ways. It can be rectally inserted as a 4% suspensionbetween 20 to 80 mL, for a holding time of 15min undergeneral anesthesia. A review which included 16 studies with202 patients found response rates ranging from 55% and 100%with 7% adverse outcomes. Formalin 10% soaked pads appliedtopically to the mucosa under endoscopic guidance results inexcellent response rates of 90% with serious complication rateof 1%.Likewise, the use of hyperbaric oxygen has shown the mostpromising benefits. The principle of this therapy is that oxygengradient promotes angiogenesis and tissue restructuring inischemic anoxic tissues. There is no level I evidence availablesupporting its use, though there is a systematic review thatwell summarizes the effectiveness of hyperbaric oxygen inthe management of radiation-induced bleeding. The maindrawback is that they are all retrospective studies that lackuniformity in symptoms and response criteria scoring and itsefficacy needs to be validated in larger randomized controlledsetting.Bladder toxicityThe urinary bladder is an important dose- limiting pelvic organwhich gets directly irradiated in gynecological malignanciesboth throughout external therapy as well as duringbrachytherapy. With this technique dose to the posterior/inferior walls of the bladder are often very high. During and270