title: Radiotherapy for inoperable and refractory endometriosis presenting with massive hemorrhage: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Radiation Oncology, Yamagata University Hospital, 2-2-2, Iida-Nishi, Yamagata City, Yamagata, 990-9585, Japan. t.nomiya@med.id.yamagata-u.ac.jp.
authors.forename: Takuma
authors.initials: T
authors.lastname: Nomiya
authors.forename: Mayumi
authors.initials: M
authors.lastname: Harada
authors.forename: Hiroko
authors.initials: H
authors.lastname: Sudo
authors.forename: Ibuki
authors.initials: I
authors.lastname: Ota
authors.forename: Mayumi
authors.initials: M
authors.lastname: Ichikawa
authors.forename: Motohisa
authors.initials: M
authors.lastname: Suzuki
authors.forename: Misako
authors.initials: M
authors.lastname: Murakami
authors.forename: Kenji
authors.initials: K
authors.lastname: Nemoto