Radiotherapy for inoperable and refractory endometriosis presenting with massive hemorrhage: a case report

INTRODUCTION: 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. CASE PRESENTATION: 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. CONCLUSIONS: 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

Influence of a multidisciplinary cancer board on treatment decisions.

BACKGROUND: To clarify how a multidisciplinary cancer board (CB) influences treatment decisions.\nMETHODS: From March 2010 to June 2011, a total of 475 cases were discussed at our CB and the minutes of the board were reviewed for this study.\nRESULTS: Of the 475 patients, minor changes in treatment methods were made in 42 patients (9 %) and major changes were made in 28 patients (6 %). Further diagnostic procedures, further publication surveys and reconfirmation of patient\u27s wishes were recommended in 80 patients (17 %). In the 392 patients for whom treatment was recommended, the CB\u27s recommendation was realized in 349 patients (89 %) and was not realized in 20 (5 %) patients.\nCONCLUSIONS: It is obvious that a CB has a great influence on cancer treatment decisions, but the effectiveness of the CB in our hospital should be verified in the future by analyzing treatment outcomes

Relationship between the quantity of serum reactive oxygen metabolites and skin toxicity grade in the irradiated rat model

The 17th ECCO- 38th ESMO- 32nd ESTRO European Cancer Congres

Radiotherapy for inoperable and refractory endometriosis presenting with massive hemorrhage: a case report

INTRODUCTION: 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.\nCASE PRESENTATION: 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.\nCONCLUSIONS: 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

Relationship between Serum Reactive Oxidative Metabolite Level and Skin Reaction in an Irradiated Rat Model

AbstractPurpose: Ionizing radiation generates free radicals and reactive oxygen species that induce DNA damage in vivo. This study aimed to determine the relationship between serum reactive oxygen metabolite (ROM) levels and skin reaction after irradiation in a rat model.Methods and materials: I. Female Wistar rats were classified into 0 Gy (control), 2 Gy, and 30 Gy groups; serum ROM levels were measured in the very acute phase. II. Other female Wistar rats were classified into 0 Gy (control), 30 Gy, 50 Gy, and 70 Gy groups; serum ROM levels were measured before and 3, 7, 16, 24, 31, and 38 days after irradiation. Skin reaction was evaluated according to the skin reaction score (0–5) twice every week.Results: Serum ROM levels in the subacute phase were significantly higher in the 50 and 70 Gy groups than in the 0 and 30 Gy groups [p = 0.029, repeated-measure analysis of variance (ANOVA)]. As expected, skin reaction scores increased in the order of the 0 Gy, 30 Gy, 50 Gy, and 70 Gy groups and differed significantly among these groups (p < 0.001, repeated-measure ANOVA). Peak serum ROM levels were observed 16 days after irradiation in all irradiated groups and corresponded with the appearance of visible skin reaction after irradiation.Conclusions: Serum ROM levels may be useful for evaluating radiation damage in mammals. Further investigations are required to investigate changes in intracellular metabolism after irradiation at gene and protein levels

Modified Simultaneous Integrated Boost Radiotherapy for Unresectable Locally Advanced Breast Cancer: Preliminary Results of a Prospective Clinical Trial.

BACKGROUND: The purpose of this study was to evaluate the effect of modified simultaneous integrated boost (SIB) radiotherapy for patients with extensive breast cancer.PATIENTS AND METHODS: Patients with macroscopic tumor and histologically proven adenocarcinoma of the breast were enrolled in the study. Patients were included whether they had or did not have previous surgery, chemotherapy, hormone therapy, or molecular targeted therapy; patients with past history of thoracic radiotherapy were excluded. Under conditions of not exceeding the tolerance dose for normal tissue, irradiation to the tumor was increased to the maximum possible extent using the modified SIB technique.RESULTS: Three breast cancer patients were treated with the modified SIB technique. All patients were diagnosed as T4b (median maximum diameter of the tumor: 16 cm; range, 15.5-22 cm), and all patients exhibited symptoms because of the extremely large tumor. The median total dose to the part of tumor tissue was 128.8 Gy (range, 110-140 Gy). Total dose to normal tissue was < 72 Gy in all patients. Although large tumors were radio-resistant, it was macroscopically confirmed that all tumors eventually disappeared. Although skin defects persisted because of tumor disappearance, there were no Grade ≥ 3 toxicities due to radiotherapy.CONCLUSION: Although much care is required in delivering extremely high doses of radiotherapy to the tumor, modified SIB radiotherapy was shown to be effective against extremely large tumors that could not be controlled using conventional radiotherapy. In future, an increase in the number of study patients and establishment of the technique will be required

Analyses of inter- and intra-fractional target motion in the lung using respiratory gating device

Purpose: The aim of this study was to evaluate intrafractional target motion under respiratory gating with the device "Abches".Methods: (A) Patients with lung cancer were performed computed tomography (CT) for radiotherapy planning (RTP) using respiratory gating system. RTP-CT were performed 5 times, continuously, and 3 dimentional errors of the target (lung tumor = GTV: gross tumor volume) motion were measured. (B) Cone Beam CT was performed for 5 times per day and was performed 5 days during clinical treatment. Distances from tumor edge to the calculated ITV (internal target volume) margin were measured and analysed.Results: Five patients with lung tumor were analyzed in this study. (A) The errors (1.96SD) of anterior, posterior, left, right, superior and inferior directions were2.5,2.6,2.2,1.1,3.6 and 2.1 mm, respectively. (B) The errors (mean 1.65SD) of distances from tumor edge to the calculated ITV (internal target volume) margin [anterior, posterior, left, right, superior and inferior] were 2.7, 0.2, 2.4, 2.7, 4.5 and 2.7 mm, respectively.Conclusion: Respiratory target motion was well reduced by the respiratory gating system "Abches". Five millimeter of ITV margins were seemed to be sufficient (includes 95% data) in the A-P and L-R directions, and 7 mm of ITV margins were seemed sufficient in the S-I direction. Five millimeter of planning target volume (PTV) margin were seemed to be sufficient in the A-P and L-R directions, and 7 mm margin was sufficient for PTV margin in S-I directions. Further study is needed.The 6th S. Takahashi Memorial Symposium & The 6th Japan-US Cancer Therapy international Joint Symposiu