Vol 26, No 3 (2021)
Case report
Published online: 2021-03-26
Radiation treatment for refractory endometriosis: a 38-year-old female presenting with vaginal bleeding
Rep Pract Oncol Radiother 2021;26(3):457-462.
Abstract
BACKGROUND: Endometriosis is typically managed with a medical or surgical approach, though some patients have medically refractory disease and are poor surgical candidates.
CASE PRESENTATION: A 39-year-old woman presented to our facility with uncontrolled bleeding and pain from an endometriotic mass at the vaginal cuff. She had a history of abdominal hysterectomy with bilateral salpingo-oophorectomy, now with medically refractive and inoperable disease due to prior history of vesicovaginal fistula. We prescribed 30 Gy in 10 fractions with 10 MV and 18 MV photons to the target. At follow-up our patient reported a complete resolution of bleeding and pelvic pain.
CONCLUSION: Radiation treatment can be an effective treatment for refractory endometriosis.
Keywords: endometriosisradiation therapyradiotherapyvaginal bleeding
References
- Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020; 382(13): 1244–1256.
- Drukała Z, Ciborowska-Zielińska B, Kubrak J, et al. Outcome of a multimodal therapy of a recurrent adenocarcinoma arising from Caesarean section scar endometriosis-A case report. Rep Pract Oncol Radiother. 2010; 15(3): 75–77.
- Shafrir AL, Farland LV, Shah DK, et al. Risk for and consequences of endometriosis: A critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018; 51: 1–15.
- Zondervan KT, Becker CM, Koga K, et al. Endometriosis. Nat Rev Dis Primers. 2018; 4(1): 9.
- Becker CM, Gattrell WT, Gude K, et al. Reevaluating response and failure of medical treatment of endometriosis: a systematic review. Fertil Steril. 2017; 108(1): 125–136.
- Alkatout I, Mettler L, Beteta C, et al. Combined surgical and hormone therapy for endometriosis is the most effective treatment: prospective, randomized, controlled trial. J Minim Invasive Gynecol. 2013; 20(4): 473–481.
- Nomiya T, Harada M, Sudo H, et al. Radiotherapy for inoperable and refractory endometriosis presenting with massive hemorrhage: a case report. J Med Case Rep. 2012; 6: 308.
- Kim KS, Moon WS, Song HW, et al. A case of persistent endometriosis after total hysterectomy with both salpingo-oophorectomy managed by radiation therapy. Arch Gynecol Obstet. 2001; 265(4): 225–227.
- Tetar S, Bruynzeel A, Bohoudi O, et al. Pitfalls of Ovarian Ablative Magnetic Resonance-guided Radiation Therapy for Refractory Endometriosis. Cureus. 2018; 10(3): e2294.
- Kochbati L, Chaari N, Néji K, et al. [Ovarian irradiation in recurrent endometriosis]. Cancer Radiother. 2005; 9(5): 341–342.
- Haglund KE, Viswanathan AN. Computed tomography-based radiation therapy of ovarian remnants for symptomatic persistent endometriosis. Obstet Gynecol. 2008; 111(2 Pt 2): 579–583.
- Thoms W, Hughes L, Rock J. Palliation of recurrent endometriosis with radiotherapeutic ablation of ovarian remnants. Fertil Steril. 1997; 68(5): 938–940.
- Picardi V, Deodato F, Guido A, et al. Palliative Short-Course Radiation Therapy in Rectal Cancer: A Phase 2 Study. Int J Radiat Oncol Biol Phys. 2016; 95(4): 1184–1190.
- Tey J, Choo BAi, Leong CN, et al. Clinical outcome of palliative radiotherapy for locally advanced symptomatic gastric cancer in the modern era. Medicine (Baltimore). 2014; 93(22): e118.
- Lee YH, Lee JW, Jang HS, et al. Palliative external beam radiotherapy for the treatment of tumor bleeding in inoperable advanced gastric cancer. BMC Cancer. 2017; 17(1): 541.
- Kawabata, R R, Kameda, C., C, Takata, A., A, et al. [A Case of Unresectable Advanced Gastric Cancer Treated with Palliative Radiation Therapy for Massive Bleeding]. Gan To Kagaku Ryoho. 2017; 44(12): 1653–1655.
- Sapienza LG, Ning MS, Jhingran A, et al. Short-course palliative radiation therapy leads to excellent bleeding control: A single centre retrospective study. Clin Transl Radiat Oncol. 2019; 14: 40–46.
- Kawabata H, Hitomi M, Motoi S. Management of Bleeding from Unresectable Gastric Cancer. Biomedicines. 2019; 7(3): 54.
- Kramer GW, Gans S, Ullmann E, et al. Hypofractionated external beam radiotherapy as retreatment for symptomatic non-small-cell lung carcinoma: an effective treatment? Int J Radiat Oncol Biol Phys. 2004; 58(5): 1388–1393.
- Gaito S, Hughes C, Woolf D, et al. Radiotherapy in the control of bleeding from primary and secondary lung tumours. Br J Hosp Med (Lond). 2019; 80(4): 211–215.
- Kim DH, Lee JuH, Ki YK, et al. Short-course palliative radiotherapy for uterine cervical cancer. Radiat Oncol J. 2013; 31(4): 216–221.
- Chen CS, Park S, Shin JiH, et al. Endovascular treatment for the control of active vaginal bleeding from uterine cervical cancer treated with radiotherapy. Acta Radiol. 2018; 59(11): 1336–1342.
- McKeown SR, Hatfield P, Prestwich RJD, et al. Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation. Br J Radiol. 2015; 88(1056): 20150405.
- Mahdjoubi A, Dendale R, Lumbroso-Le Rouic L, et al. Retinal cavernous haemangioma treated by proton beam therapy. Int Ophthalmol. 2018; 38(2): 759–762.
- Viswanathan AN, Lee LJ, Eswara JR, et al. Complications of pelvic radiation in patients treated for gynecologic malignancies. Cancer. 2014; 120(24): 3870–3883.
- Wo JY, Viswanathan AN. Impact of radiotherapy on fertility, pregnancy, and neonatal outcomes in female cancer patients. Int J Radiat Oncol Biol Phys. 2009; 73(5): 1304–1312.
- Dracham CB, Shankar A, Madan R. Radiation induced secondary malignancies: a review article. Radiat Oncol J. 2018; 36(2): 85–94.
- Clayton RD, Hawe JA, Love JC, et al. Recurrent pain after hysterectomy and bilateral salpingo-oophorectomy for endometriosis: evaluation of laparoscopic excision of residual endometriosis. Br J Obstet Gynaecol. 1999; 106(7): 740–744.
- Namnoum A, Hickman T, Goodman S, et al. Incidence of symptom recurrence after hysterectomy for endometriosis. Fertil Steril. 1995; 64(5): 898–902.
- Shakiba K, Bena JF, McGill KM, et al. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol. 2008; 111(6): 1285–1292.
- Magtibay PM, Nyholm JL, Hernandez JL, et al. Ovarian remnant syndrome. Am J Obstet Gynecol. 2005; 193(6): 2062–2066.
- Kho RM, Abrao MS. Ovarian remnant syndrome: etiology, diagnosis, treatment and impact of endometriosis. Curr Opin Obstet Gynecol. 2012; 24(4): 210–214.
- Sakata R, Kleinerman RA, Mabuchi K, et al. Cancer mortality following radiotherapy for benign gynecologic disorders. Radiat Res. 2012; 178(4): 266–279.
- Brosset A. The value of irradiation therapy in the treatment of endometriosis. Acta Obstet Gynecol Scand. 1957; 36(2): 209–225.
- Palmer J, Spratt D. Pelvic carcinoma following irradiation for benign gynecological diseases. Am J Obstet Gynecol. 1956; 72(3): 497–505.