Radiotherapy has become an established treatment option for prostate cancer, with modalities such as intensity-modulated radiation therapy (IMRT), image-guided radiation therapy, brachytherapy, and particle beam radiation therapy offering comparable outcomes to surgery. Although acute lower urinary tract symptoms (LUTS) often improve shortly after the completion of definitive radiotherapy for prostate cancer, late-onset symptoms can recur months to years later, sometimes showing resistance to conventional pharmaceutical interventions. This paper reports three cases in which ryutanshakanto, a traditional herbal medicine, demonstrated effectiveness in treating LUTS resulting from acute and late radiation toxicity following definitive radiotherapy for prostate cancer. Case 1involved a patient who experienced late radiation prostatitis and urethritis with LUTS 1 year and 5 months after brachytherapy. Case 2 presented acute radiation-induced LUTS following IMRT, while Case 3 experienced late-onset LUTS more than 5 years after IMRT. In these cases, conventional Western medications failed to control the symptoms adequately, but ryutanshakanto proved to be an effective alternative.

We report a case of a 57-year-old woman with radiation proctitis (RP) treated by shiunko (SK) enema with promising outcomes. The patient underwent interstitial brachytherapy for anterior vaginal vault recurrence of uterine cancer. Nine months after the treatment, she had anal pain and was diagnosed with RP by clinical course and colonoscopy. The rectal ulcer was so severe that a surgeon proposed permanent stoma formation as one option, given eventual risk of rectovaginal fistula. The patient rejected stoma formation and opted for Kampo medicine. Though she took keishibukuryogankayokuinin for blood stasis at first, her anal pain and rectal bleeding gradually worsened. Thereafter, she mainly used SK enema, kyukikyogaito and magnesium oxide. Anal pain and rectal bleeding decreased after applying SK to the rectal wall per rectum. Magnetic resonance imaging (MRI) and colonoscopy findings of the rectal ulcer also improved. SK effectively reduced anal pain and rectal bleeding as well as stimulated tissue repair in our patient, and therefore SK is worth considering in the treatment of RP.

Shiunko, topical herbal ointment, has been used in Japan for hemorrhoid and skin wound such as scratch, incision and burn. We report two cases of radiation dermatitis with erosion, which have a good outcome after treatment with shiunko. Case 1 was 72-year-old man with radiation dermatitis of bilateral inguinal region caused by postoperative irradiation for bilateral inguinal lymph node metastases from penile cancer. Re-epithelization was observed in erosion on the 10th day after applying shiunko. It showed earlier recovery from radiation dermatitis than the cases treated with topical external medicine of azulene and/or steroid. Case 2 was 60-year-old man with the perianal radiation dermatitis with pain caused by pelvic radiotherapy for recurrence of advanced rectal cancer after chemotherapy. Shiunko gave rapid relief from anal pain and the patients felt no pain on the day subsequent to applying shiunko. Shiunko hastens analgesic effectiveness and improvement of wound caused by radiotherapy.