Long-term control of refractory hemorrhagic radiation proctitis with ozone therapy

J Pain Symptom Manage. 2013 Jul;46(1):106-12. doi: 10.1016/j.jpainsymman.2012.06.017. Epub 2012 Oct 26.


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=17; median age 69 years [range 42-80 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 3-56 months).

Results: Endoscopic treatments required were: 43 (median 1; range 0-10) pre-O3T; 17 (median 0; range 0-8; P=0.063) during O3T; and five (median 0; range 0-2; P=0.008) during follow-up. Hemoglobin levels were 10.35g/dL (7-14g/dL) pre-O3T and 13g/dL (9-15g/dL) (P=0.001) post-O3T. Median toxicity grades were 3 (range 2-4) pre-O3T, 1 (range 0-2; P<0.001) at the end of O3T, and 0 (range 0-1; 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 management of HRP and, as such, merits further evaluation.

Keywords: Gynecologic tumors; integrative and complementary medicine; pelvic radiotherapy; prostate cancer; rectal bleeding; side effects; toxicity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy*
  • Humans
  • Male
  • Middle Aged
  • Ozone / therapeutic use*
  • Proctitis / etiology
  • Proctitis / therapy*
  • Prostatic Neoplasms / radiotherapy
  • Radiation Injuries / therapy*
  • Radiotherapy / adverse effects*
  • Treatment Outcome
  • Uterine Neoplasms / radiotherapy


  • Ozone