Thursday, 25 October 2012

Nuking Endometriosis

Endometriosis is a notoriously difficult condition to treat; there are the drug therapies, but they are often hit or miss and can come with a plethora of unpleasant side effects. Then there is surgical treatment, which has the advantage of a better rate of relieving symptoms but it cannot guarantee the disease won’t return later, which may result in more surgery. Either way there always seems some medical or surgical options available, but what happens when the options run out?

A recent case report from Yamagata University Hospital in Japan starts with the authors finding themselves in that very situation. They were presented with a 47 year old woman with endometriosis (specifically chocolate cysts on both ovaries) who also experienced abnormal vaginal bleeding to the point where she was requiring blood transfusions. Medical therapy for her endometriosis didn’t help so the next logical step would be surgery, right? Not in this case, unfortunately the woman in question also suffered from idiopathic thrombocytopenic purpura (mercifully shortened to ITP) which means she has an abnormally low red blood cell count, making surgical intervention extremely dangerous.

Her doctors clearly weren’t in the giving up mood and in an inspired move decided maybe radiotherapy was the answer. You’ve probably heard of radiotherapy before but it’s normally used to treat tumours. In this case though the doctors elected to create a ‘radiation induced menopause’ by targeting the woman’s ovaries and endometrium with controlled doses of radiation. The authors report that after this course of radiotherapy the woman’s symptoms had abated and the abnormal vaginal bleeding had stopped.

Overall this was an extreme but successful treatment option for this patient. It’s not the first instance of radiotherapy for endometriosis either, but it is incredibly rare that this method is employed, mainly because it’s unusual for a patient to not respond to medical therapy and be unable to have surgical treatment. Also a major drawback is the irreversible loss of all ovarian function, so it would not be recommended for anyone who ever wants a family and hormone replacement therapy would probably be needed to control menopausal symptoms.  

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