title: Intensity-modulated radiotherapy for a rendu-osler-weber disease patient with recurrent severe epistaxis: a case report.
abstract: We present a case of a Rendu-Osler-Weber disease patient with recurrent life threatening epistaxis demanding multiple blood transfusions despite of repetitive endoscopic laser and electrocoagulations, endovascular embolisation, septodermoplasty, and long-term intranasal dressings. As alternative treatment modalities repeatedly failed and the patient became almost permanently dependent on nasal dressing, we performed a highly conformal intensity-modulated radiotherapy of the nasal cavity; a total dose of 50 Gy in 2 Gy single fractions was applied. The therapy was very well tolerated, no acute toxicities occurred. Two weeks after the last radiation dose had been applied, the nasal dressing could be removed without problems. Endoscopical control revealed an almost avascular white mucosa without any trace of bleeding spots; previously existing hemangiomas and crusts had disappeared. After a 1-year-follow up, the patient had no significant recurrent epistaxis.
authors.affiliation: Department of Radiation Oncology, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Niyazi
authors.forename: Marco-Domenico
authors.initials: MD
authors.lastname: Caversaccio
authors.forename: Patrick
authors.initials: P
authors.lastname: Dubach
authors.forename: Andreas
authors.initials: A
authors.lastname: Geretschläger
authors.forename: Andreas
authors.initials: A
authors.lastname: Arnold
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Aebersold
authors.forename: Norbert M
authors.initials: NM
authors.lastname: Blumstein