Nomiya Takuma, Harada Mayumi, Sudo Hiroko, Ota Ibuki, Ichikawa Mayumi, Suzuki Motohisa, Murakami Misako, Nemoto Kenji
Department of Radiation Oncology, Yamagata University Hospital, 2-2-2, Iida-Nishi, Yamagata City, Yamagata, 990-9585, Japan.
J Med Case Rep. 2012 Sep 18;6:308. doi: 10.1186/1752-1947-6-308.
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.
许多子宫内膜异位症患者接受药物治疗或手术治疗。然而，少数患者对药物无反应，且因合并症而无法进行手术。本病例报告展示了放射治疗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。
一名47岁的亚洲女性因药物治疗无法控制的难治性子宫内膜异位症前来我院就诊。由于严重的特发性血小板减少性紫癜，该患者被认为无法进行手术，并因大量生殖器出血需要输血而接受了放射治疗。对包括双侧卵巢、子宫和肌瘤在内的盆腔给予10次分割共20Gy的放射剂量。对子宫内膜额外给予5次分割共10Gy的放射剂量以控制残余出血。放射治疗后第46天生殖器出血完全得到抑制。激素分析显示放射治疗导致了绝经状态。放射治疗两年后，非典型生殖器出血未再复发，且得到了良好控制，无副作用。
卵巢功能破坏是放射治疗的一种不良反应。然而，放射治疗可用于诱导绝经。在药物难治性或无法手术的子宫内膜异位症病例中，放射治疗将是一种有效的治疗选择。
