Long-Term Control of Refractory Hemorrhagic Radiation Proctitis With Ozone Therapy  Bernardino Clavo, MD, PhD, Daniel Ceballos, MD, Dominga Gutierrez, RN, Gloria Rovira, MD, PhD, Gerardo Suarez, RN, Laura Lopez, RN, Beatriz Pinar, MD, PhD, Auxiliadora Cabezon, MD, Victoria Morales, MD, Elena Oliva, MD, Dolores Fiuza, MD, PhD, Norberto Santana-Rodriguez, MD, PhD  Journal of Pain and Symptom Management  Volume 46, Issue 1, Pages 106-112 (July 2013) DOI: 10.1016/j.jpainsymman.2012.06.017 Copyright © 2013 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 1 Rectal hemorrhage grading according to CTCAE (see Materials and Methods section for details). Initial CTCAE toxicity grade (median 3; range 2–4) was significantly decreased at the end of O3T (median 1; range 0–2; P<0.001) and at the last follow-up assessment (median 0; range 0–1; P<0.001). Grade 0: no symptoms; Grade 1: mild symptoms, intervention not indicated; Grade 2: moderate symptoms, medical intervention or minor cauterization indicated; Grade 3: severe symptoms, transfusion, radiologic, endoscopic, or elective surgical intervention indicated; Grade 4: life-threatening consequences, urgent intervention indicated. CTCAE=Common Terminology Criteria for Adverse Events; O3T=ozone therapy. Journal of Pain and Symptom Management 2013 46, 106-112DOI: (10.1016/j.jpainsymman.2012.06.017) Copyright © 2013 U.S. Cancer Pain Relief Committee Terms and Conditions

Fig. 2 Summary of outcomes of O3T. Values are shown as median and range (minimum and maximum values) except for the numbers of endoscopic treatments. ∗Friedman's test. ∗∗Chi-square test. ∗∗∗Wilcoxon signed rank test. RT=radiotherapy; O3T=ozone therapy; CTCAE=Common Terminology Criteria for Adverse Events. Journal of Pain and Symptom Management 2013 46, 106-112DOI: (10.1016/j.jpainsymman.2012.06.017) Copyright © 2013 U.S. Cancer Pain Relief Committee Terms and Conditions