Radiotherapy for inoperable and refractory endometriosis presenting with massive hemorrhage: a case report.
Radiotherapy for inoperable and refractory endometriosis presenting with massive hemorrhage: a case report.
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DOI：
10.1186/1752-1947-6-308
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发表时间：
2012-09-18
影响因子：
1
通讯作者：
Nemoto K
中科院分区：
文献类型：
--
作者：
Nomiya T;Harada M;Sudo H;Ota I;Ichikawa M;Suzuki M;Murakami M;Nemoto K
许多子宫内膜异位症患者通过药物治疗或手术治疗。然而，一小部分患者对药物治疗没有反应，并且由于合并症而不能手术。本病例报告显示了放射治疗对难治性子宫内膜异位症的有效性，并包括血清雌二醇水平的时间序列。一位47岁的亚洲女性因药物治疗无效的子宫内膜异位症来我院就诊。我们的病人被认为是不能手术，因为严重的特发性血小板减少性紫癜，并接受放射治疗的大量生殖器出血需要输血。将20 Gy的放射剂量分10次输送到骨盆，包括双侧卵巢、子宫和肌瘤。另外10Gy分5次递送到子宫内膜以控制残余出血。放疗后第46天，生殖器出血得到完全抑制。激素分析显示，放射治疗引起的绝经后状态。放疗后两年，非典型生殖器出血没有复发，并且得到了很好的控制，没有副作用。卵巢功能紊乱是放疗的副作用。然而，放射治疗可用于诱导绝经。在药物难治性或不可手术的子宫内膜异位症的情况下，放射治疗将是一种有效的治疗选择。
Many patients with endometriosis are treated with medication or by surgical approaches. However, a small number of patients do not respond to medication and are inoperable because of comorbidities. This case report shows the effectiveness of radiotherapy for refractory endometriosis and includes a time series of serum estradiol levels. A 47-year-old Asian woman presented to our facility with uncontrolled endometriosis refractory to medication. Our patient was considered inoperable because of severe idiopathic thrombocytopenic purpura, and underwent radiotherapy for massive genital bleeding requiring blood transfusions. A radiation dose of 20Gy in 10 fractions was delivered to the pelvis, including the bilateral ovaries, uterus, and myomas. An additional 10Gy in five fractions was delivered to the endometrium to control residual bleeding. Genital bleeding was completely inhibited on day 46 after radiotherapy. Hormonal analysis revealed that radiotherapy induced post-menopausal status. Two years after radiotherapy, atypical genital bleeding had not recurred and has been well controlled without side effects. Disrupted ovarian function is an adverse effect of radiotherapy. However, radiotherapy can be useful for inducing menopause. In cases of medication-refractory or inoperable endometriosis, radiotherapy would be an effective treatment option.