S1432 Cryotherapy in the Treatment of Radiation Proctitis: A Literature Review

Introduction: Radiation proctitis (RP) occurs in up to 20% of pelvic radiotherapy patients. While Argon Plasma Coagulation (APC) is standard therapy, it carries risks such as rectal pain, diarrhea, fistula, and stricture formation. Cryotherapy is a non-contact ablation method used in esophageal dysplasia, which is now being explored for RP. We conducted a comprehensive review of the available literature to evaluate the efficacy and safety of cryotherapy in managing bleeding secondary to RP. Methods: A systematic literature search was conducted until May 2025, across 5 major databases: Medline, Embase, Scopus, Web of Science, and Cochrane CENTRAL. Studies reporting clinical or endoscopic data of cryotherapy in adult patients with radiation proctitis were included. A descriptive analysis of clinical symptom improvement and mucosal healing, with adverse events reported in the included studies, were summarized. Results: Six studies encompassing a total of 28 patients, met the inclusion criteria. These studies included 3 case series and 3 case reports. Most patients were men (n = 26; 93%), with a mean age of 69.9 years. Prostate cancer was the most common underlying malignancy, reported in 93% of cases. Liquid nitrogen was the cryogen used in nearly all patients (n = 27; 96%), with carbon dioxide used in only one case. The majority of patients (n = 19; 68%) underwent a single cryotherapy session. Prior treatment was reported in 4 studies with APC being the most common (n = 5; 29.4%). Follow up period ranged from 11 to 105 days, with most patients followed up between 30 and 90 days. All of the included studies reported endoscopic improvement on follow up endoscopy. Four out of the 6 studies also reported clinical improvement in the form of bleeding or pain. One serious adverse event (AE) of a cecal perforation (n = 1; 4%) was thought to be due to failure of the decompression tube. This patient required a right hemicolectomy. Remaining AE included rectal ulcers (n = 3; 11%), transient abdominal distension (n = 3, 11%), and rectal bleeding (n = 1, 4%). Conclusion: Cryotherapy appears safe and effective for RP, offering clinical and endoscopic improvement with a favorable adverse event profile. Further prospective trials are warranted to assess efficacy and safety in the longterm.