title: Bone marrow-sparing intensity-modulated radiotherapy (IMRT) for neo-adjuvant therapy of inoperable cervical cancer in a patient with severe thrombocytopenia.
abstract: BACKGROUND
  Therapy possibilities are limited in patients with cervix carcinoma and thrombocytopenia.
  
  
  METHODS
  We describe a 50-year-old woman with inoperable cervical carcinoma and chronic lymphatic B cell leukemia (B-CLL). Due to thrombocytopenia, a combined radiochemotherapy could not be performed. Intensitymodulated radiotherapy (IMRT) aiming at maximal bone sparing was planned. After a total dose of 45 Gy, a laparoscopic omentum plastic was performed to enable radiotherapy (RT) to full dose. 3 days later, an external beam boost was restarted to a cumulative dose of 50.4 Gy. Regular blood analysis showed low but stable blood counts. 4 weeks after RT, magnetic resonance imaging (MRI) showed a 30% regression of the tumor volume and, after transfusion of fresh-frozen plasma, a hysterectomy could be performed. 6 months after therapy, no recurrence or late toxicities had occurred.
  
  
  CONCLUSIONS
  The clinical implementation of IMRT may potentially improve the therapeutic outcome of patients with cervix cancer, allowing dose escalation without increasing normal-tissue toxicity.
authors.affiliation: Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Germany. anna.simeonova@umm.de
authors.forename: Anna
authors.initials: A
authors.lastname: Simeonova
authors.forename: Yasser
authors.initials: Y
authors.lastname: Abo-Madyan
authors.forename: Philipp
authors.initials: P
authors.lastname: Ströbel
authors.forename: Werner
authors.initials: W
authors.lastname: Kleine
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwarzbach
authors.forename: Katharina
authors.initials: K
authors.lastname: Fleckenstein
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
mesh_terms: D001855:Bone Marrow Diseases / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods*; D013921:Thrombocytopenia / Q000150:complications*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000532:radiotherapy*