Context. Persistent or severe hemorrhagic radiation proctitis (HRP) has limited therapeutic options.
Objectives. To describe our experience with ozone therapy (O3T) in the management of refractory HRP.
Methods. Patients (n 1⁄4 17; median age 69 years [range 42e80 years]) previously irradiated for prostate or uterine cancer and suffering persistent or severe HRP without response to conventional treatment were enrolled to receive an O3/O2 gas mixture via rectal insufflations and topical application of ozonized oil. Most of the patients (83%) had Grade 3 or Grade 4 toxicity. Median follow-up post-O3T was 40 months (range 3e56 months).
Results. Endoscopic treatments required were 43 (median 1; range 0e10) pre- O3T, 17 (median 0; range 0e8; P 1⁄4 0.063) during O3T, and five (median 0; range 0e2; P 1⁄4 0.008) during follow-up. Hemoglobin levels were 10.35 g/dL
(7e14 g/dL) pre-O3T and 13 g/dL (9e15 g/dL) (P 1⁄4 0.001) post-O3T. Median toxicity grades were 3 (range 2e4) pre-O3T, 1 (range 0e2; P < 0.001) at the end of O3T, and 0 (range 0e1; P < 0.001) at the last follow-up.
Conclusion. Persistent advanced HRP was significantly improved with O3T. The addition of O3T can be useful as a complementary treatment in the long-term.