Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan.
J Med Case Rep. 2024 May 10;18(1):239. doi: 10.1186/s13256-024-04551-x.
Radiation proctitis (RP) is a significant complication of pelvic radiation. Effective treatments for chronic RP are currently lacking. We report a case where chronic RP was successfully managed by metformin and butyrate (M-B) enema and suppository therapy.
A 70-year-old Asian male was diagnosed with prostate cancer of bilateral lobes, underwent definitive radiotherapy to the prostate of 76 Gy in 38 fractions and six months of androgen deprivation therapy. Despite a stable PSA nadir of 0.2 ng/mL for 10 months post-radiotherapy, he developed intermittent rectal bleeding, and was diagnosed as chronic RP. Symptoms persisted despite two months of oral mesalamine, mesalamine enema and hydrocortisone enema treatment. Transition to daily 2% metformin and butyrate (M-B) enema for one week led to significant improvement, followed by maintenance therapy with daily 2.0% M-B suppository for three weeks, resulting in continued reduction of rectal bleeding. Endoscopic examination and biopsy demonstrated a good therapeutic effect.
M-B enema and suppository may be an effective treatment for chronic RP.
放射性直肠炎（RP）是盆腔放疗的一种严重并发症。目前缺乏治疗慢性 RP 的有效方法。我们报告了一例使用二甲双胍和丁酸盐（M-B）灌肠和栓剂治疗慢性 RP 获得成功的病例。
一名 70 岁亚裔男性，诊断为双侧叶前列腺癌，接受了前列腺的根治性放疗，剂量为 76 Gy，共 38 次，以及 6 个月的雄激素剥夺治疗。尽管放疗后 PSA 最低值在 10 个月内稳定在 0.2ng/mL，但他仍出现间歇性直肠出血，被诊断为慢性 RP。尽管接受了两个月的口服美沙拉嗪、美沙拉嗪灌肠和氢化可的松灌肠治疗，症状仍持续存在。改为每日 2%二甲双胍和丁酸盐（M-B）灌肠治疗一周后，症状显著改善，随后每日 2.0%M-B 栓剂维持治疗三周，直肠出血持续减少。内镜检查和活检显示治疗效果良好。
M-B 灌肠和栓剂可能是治疗慢性 RP 的有效方法。
