Radiotherapy for successful symptom control in recurrent refractory endometriosis: A case report.

ABSTRACT: Endometriosis is a benign gynecological condition which induces a chronic inflammatory process, characterized by the presence of endometrium-like tissue outside the uterus. Treatment options for endometriosis include medical, surgical, or both. Irrespective of the treatment approach, recurrence of symptoms is not rare. We report the use of radiotherapy in a patient with recurrent refractory endometriosis, not responding to conventional treatments. At lower doses, radiotherapy can modulate the inflammatory cascade and can also does ovarian ablation. She was treated using 6MV photons with a four-field box to a total dose of 30Gy in 10 fractions. The pelvic radiotherapy field also included the ovarian remnant. Her symptoms regressed within one week of radiation treatment and is now symptom free for six months, with good quality of life.

Effect of Pulsed High-Intensity Laser Therapy on Pain, Adhesions, and Quality of Life in Women Having Endometriosis: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to assess the effectiveness of pulsed high-intensity laser therapy on pain, adhesions, and quality of life in women with endometriosis. BACKGROUND DATA: Endometriosis is among the most common gynecological problems affecting females of childbearing age. The majority of women with endometriosis seek treatment to alleviate pain. MATERIALS AND METHODS: The sample included 40 women with endometriosis to either a mild or a moderate degree aged between 24 and 32 years. They were randomly assigned to two groups, group I of 20 women received pulsed high-intensity laser therapy three times per week for 8 weeks, as well as the usual regimen of hormonal treatment given to endometriosis patients, and group II of 20 women were given sham laser treatment three times per week for 8 weeks and the usual regimen of hormonal treatment. For all patients, pain, the degree of endometriosis, and quality of life were measured using present pain intensity and pain relief scales, laparoscopy, and the Endometriosis Health Profile (EHP-5) before treatment began and at the end of the 8 weeks. RESULTS: In comparison to the sham laser treatment, pulsed high-intensity laser therapy produced a significantly different result (p < 0.0001), in women with endometriosis. CONCLUSIONS: Pulsed high-intensity laser therapy is an effective method of pain alleviation, reducing adhesions, and improving the quality of life in women with endometriosis.

[Triple synchronous primary gynaecological tumours. A case report]. / Tumores triple sincrónicos ginecológicos. Reporte de un caso.

BACKGROUND: Synchronous multiple primary malignancies in the female genital tract are infrequent. From 50 to 70% of them corresponds to synchronous cancers of the endometrium and ovary. To our knowledge, this is only the third case report in the international literature of three concurrent gynaecological cancers of epithelial origin. A case is presented, as well as a literature review due to the infrequency of its diagnosis and the lack of information on the subject. CLINICAL CASE: A 49-year-old woman, with previous gynaecological history of ovarian endometriosis. She underwent a hysterectomy and bilateral oophorectomy, as she had been diagnosed with endometrial hyperplasia with atypia. The final histopathology reported synchronous ovarian, Fallopian tube, and endometrial cancer. An extension study and complete surgical staging was performed, both being negative. She received adjuvant treatment of chemotherapy and radiotherapy. She is currently free of disease. CONCLUSIONS: The aetiology is uncertain. There is controversy relating to increased susceptibility of synchronous neoplasms to pelvic endometriosis and inherited genetic syndromes. Its diagnosis needs to differentiate them from metastatic disease. Additionally, they are problematical from a clinical, diagnostic, therapeutic, and prognostic point of view. The presentation of more cases of triple synchronous cancers is necessary for a complete adjuvant and surgical treatment.

Gamma-ray energy absorption and exposure buildup factor studies in some human tissues with endometriosis.

Human tissues with endometriosis have been analyzed in terms of energy absorption (EABF) and exposure (EBF) buildup factors using the five-parameter geometric progression (G-P) fitting formula in the energy region 0.015-15 MeV up to a penetration depth of 40 mfp (mean free path). Chemical compositions of the tissue samples were determined using a wavelength dispersive X-ray fluorescence spectrometer (WDXRFS). Possible conclusions were drawn due to significant variations in EABF and EBF for the selected tissues when photon energy, penetration depth and chemical composition changed. Buildup factors so obtained may be of use when the method of choice for treatment of endometriosis is radiotherapy.

Laparoscopic approach to right diaphragmatic endometriosis with argon laser: case report.

Diaphragmatic involvement by an endometriotic cyst is a rare entity that may be responsible for chronic thoracic pain. Herein we present a case report of a 6-cm right diaphragmatic endometrioma treated using laparoscopic partial excision and argon laser coagulation of the inner cyst wall. The laparoscopic approach to upper abdomen endometriosis is feasible and safe when accurate evaluation of the case is performed.

Computed tomography-based radiation therapy of ovarian remnants for symptomatic persistent endometriosis.

BACKGROUND: Endometriosis, a major cause of pelvic pain in women, is driven by estrogen. Ovarian remnant irradiation may alleviate pelvic pain by eliminating estrogen production in appropriately selected women with endometriosis. CASE: Three patients with endometriosis causing incapacitating pelvic pain received 3D-imaging-based external beam radiation to doses of 1,500 to 2,100 cGy. All had pre-irradiation premenopausal follicle stimulating hormone levels and imaging evidence of ovarian remnants. None were candidates for further medical or surgical interventions. By 3 months after radiation, follicle stimulating hormone levels reached postmenopausal levels in all three patients, with complete resolution of the severe pelvic pain. CONCLUSION: Radiation therapy effectively induced menopause and relieved refractory pain from endometriosis. Careful selection of patients is necessary, given the potential for an increased long-term risk of radiation-related complications.

[Ovarian irradiation in recurrent endometriosis]. / Irradiation ovarienne pour endométriose réfractaire inopérable.

We describe a case of a young woman with a history of an aplastic anaemia in which pelvic radiotherapy was used successfully in the management of a recurrent and inoperable endometriosis. The use of therapeutic pelvic or ovarian irradiation in endometriosis may be considered, when surgical and medical treatments have been exhausted and have failed.

A case of persistent endometriosis after total hysterectomy with both salpingo-oophorectomy managed by radiation therapy.

Persistent endometriosis after total hysterectomy and both salpingo-oophorectomy (TH with BSO) is a rare condition and the etiology is uncertain. The exact incidence of persistent endometriosis after definitive surgery is not known. In addition, the treatment of persistent endometriosis after complete surgical excision is controversial. We report a case of persistent endometriosis with vaginal and sigmoid-colonic invasion after TH with BSO. The lesions were not responsive to hormonal therapy. The patient was managed successfully by therapeutic pelvic radiation.

Palliation of recurrent endometriosis with radiotherapeutic ablation of ovarian remnants.

OBJECTIVE: To review the use of radiotherapy for relieving the symptoms of recurrent endometriosis caused by functioning ovarian remnants. DESIGN: Retrospective study (case report). PATIENT(S): A woman with recurrent endometriosis of 14 years' duration. INTERVENTION(S): After hysterectomy and bilateral oophorectomy, hormonal management, and multiple explorations for recurrent endometriosis, cycling ovarian remnants were confirmed histologically. Pelvic irradiation was used to ablate this tissue. A dose of 15 Gy in 10 daily fractions was given through anterior and posterior opposed fields using 18-mV photons. RESULT(S): The patient had a prompt increase in FSH levels associated with castration levels of serum E2. A review of the literature on the use of radiotherapy in this clinical situation is presented. CONCLUSION(S): Radiotherapy should be considered in selected patients when ovarian castration is not a viable surgical option and hormonal therapies have failed.

[Müllerian adenosarcoma. Apropos of a case]. / L'adénosarcome Müllérien. A propos d'un cas.

Müllerian adenosarcoma is an uncommon disease of the female genital tract with a special place among mixed müllerian tumors because of its slow and more favorable clinical course. This tumor is composed of a benign epithelial contingent and a sarcomatous one. A case of Müllerian adenosarcoma clinically characterized by an atypical outset is described and the literature is reviewed.

Combined assessment of vascular and myometrial invasion as a model to predict prognosis in stage I endometrioid adenocarcinoma of the uterine corpus.

The prognostic significance of vascular invasion as compared with other pathologic features was evaluated in 102 cases of endometrioid adenocarcinoma confined to the uterus (Stage I) treated by hysterectomy. By univariate analysis, survival most closely correlated with patient age, architectural grade, depth of myometrial invasion, vascular invasion, and the presence of perivascular lymphocytic infiltrates. Among these, vascular invasion and the presence of perivascular lymphocytic infiltrates were the best indicators of prognosis. In contrast to perivascular lymphocytic infiltrates, the presence of a lymphocytic infiltrate at the tumor-myometrial junction was not related to outcome. The presence of vascular invasion was found to be associated closely with perivascular lymphocytic infiltrates. These two features may be related biologically and were designated "vascular invasion-associated changes." By multivariate analysis with the Cox proportional hazards model, the depth of myometrial invasion and the presence of vascular invasion-associated changes were found to provide a highly reliable model for predicting outcome. The highly predictive value of vascular invasion as a prognostic factor in Stage I endometrial carcinoma suggests that it is the mechanism by which occult metastasis develops in patients whose disease progresses after hysterectomy. It is likely that other variables correlating with recurrence, such as the presence of deep myometrial invasion and high tumor grade, may act by increasing the probability of vascular invasion and subsequent metastasis.

[YAG laser contact therapy of ovarian endometriosis under laparoscopy].

Thirty-six patients with ovarian endometriosis were treated with Nd:YAG laser contact irradiation under laparoscopic control. Indications for laparoscopy were infertility (n = 20) and dysmenorrhea (n = 16). The laparoscopic procedures so far undertaken in our clinic include: Aspiration of chocolate cyst, removal of ovarian endometriosis, adhesion-lysis, uterine nerve ablation, coagulation of peritoneal endometriosis and irrigation. No complications were seen. After undergoing this procedure, eight of 20 patients achieved pregnancy and 15 of 16 patients obtained pain relief. Serum CA125 levels were significantly decreased postoperatively. We confirmed that contact irradiation with a cone-shaped sapphire probe provides adequate incision and lysis at lower power levels, and that this method is an effective treatment for ovarian endometriosis.

[Our experience in treating endometrioid ovarian carcinoma]. / Nashiiat opit v lechenieto na endometroidniia ovarialen kartsinom.

The authors describe 12 women with endometrioid ovarian carcinoma at the age of 28 to 74 years. Endometrioid carcinoma is accompanied by endometrial carcinoma in 4 women. Five patients are at I stage, 5 patients--at II stage and 1 patient--at III and IV stage. All women are operated and have total hysterectomy with bilateral adnexectomy and 7 women have omectomy and 5 are without omectomy. All are treated by postoperative telegammatherapy: 8 patients-at the region of the pelvis 1--woman-at the pelvis and para-aortal lymph chains, 2 patients--with band irradiation of the whole abdomen and 1 woman is irradiated palliatively. 7 out of 8 patients treated radically and followed over 5 years, are clinically healthy and only 1 is dead and she been at III stage. In the last case there has been mesonephroid component and it has caused probably more malignant course of the disease. An inference is made that the complex treatment of endometrioid carcinoma of the ovary--radical operation and postoperative irradiation, gives good results.

Chylous ascites after whole-abdomen irradiation for gynecologic malignancy.

From November 1981 through December 1987, 207 patients received whole-abdomen irradiation (WAI) for gynecologic malignancies at the Mayo Clinic. In seven (3%) of these patients, chylous ascites subsequently developed; one additional patient with chylous ascites after WAI for a gynecologic malignancy was referred to us from another institution. In these eight patients, irradiation was done either adjuvantly (five patients) or as salvage therapy after chemotherapy failure (three patients). Chylous ascites was confirmed by laboratory analysis in six cases and was presumed based on the clinical course in two cases. Mean cumulative radiation doses were 2,925 and 5,122 cGy to the abdomen and pelvis, respectively, with para-aortic boosts administered in six cases to a mean cumulative dose of approximately 4,200 cGy. The mean time from completion of WAI to development of ascites was 12 months (range, 6 to 18 months). In six patients, therapy was conservative-observation and diuretics. Two other patients required multiple paracenteses for relief of abdominal distention. Parenteral nutrition was given to two patients who had associated radiation enteritis. The ascites resolved in all eight cases at a mean of 18 months (range, 8 to 30 months) after development. At a mean follow-up of 57 months after initial diagnosis and 16 months after resolution of the ascites, seven patients are without evidence of disease and one patient died of recurrent carcinoma. Distinguishing this clinical entity from recurrent carcinoma is important because of its benign course and its resolution with conservative management.

Intraperitoneal radiolabeled OC 125 in patients with advanced ovarian cancer.

Twenty patients with recurrent or persistent epithelial ovarian cancer failing conventional therapies were treated with a single intraperitoneal injection of iodine-131-labeled OC 125 monoclonal antibody. Rare acute side effects were nausea and mild diarrhea. At doses up to 120 mCi of iodine-131, median white blood cell and platelet count nadirs were 3.6k/microliters and 187k/microliters, respectively. Two patients acquired thyroid toxicities despite thyroid blockage with "cold" iodine. One patient had transient TSH elevation while remaining clinically euthyroid, and 1 patient developed activation of a thyroid nodule and clinical hyperthyroidism. Dose-limiting toxicity has not yet been observed. Twelve of 20 patients are alive 3 to 17 months following therapy. Tumor progression was noted in the majority of patients, although 3 patients had documented decreases in tumor burden of short duration. We conclude that, at the doses examined, iodine-131 OC 125 can be safely administered intraperitoneally.

Intraperitoneal radioactive chromic phosphate P 32 in the treatment of ovarian cancer.

The use of intraperitoneal radioisotopes in the management of women with ovarian cancer is controversial. We analyzed the experience with intraperitoneal chromic phosphate P 32 at our institution, from October 1979 to February 1983, in 22 patients with various stages and grades of ovarian malignancy. Survival in stage I is 87.5% and in stage II, 50%. Survival is 88.9% among patients with grade 1 tumors and 33.3% for those with grade 3 lesions. Morbidity related to chromic phosphate P 32 was minimal; small bowel obstruction occurred in only one patient who had also received external pelvic irradiation. Our results suggest that chromic phosphate P 32 is a safe, well tolerated, inexpensive, and effective adjuvant to surgery in the management of selected patients with ovarian malignancy.

Preoperative radiation therapy in advanced carcinoma of the ovary.

Preoperative radiotherapy in advanced ovarian carcinoma was evaluated. The overall 5-year survival rate in the irradiated group was 27%. When tumour mass remaining after operation was less than 2 cm in diameter, this figure rose to 52%. Comparison was made between those in whom operation became feasible only after preoperative irradiation and patients in advanced stages who were primarily successfully operated to less than 2 cm and with a 5-year survival rate of 44%. Selection of the cases for preoperative radiotherapy is obviously necessary. Fixed, bulky tumours in the pelvis, with or without metastases, may be suitable for preoperative radiotherapy.

[Total abdominal irradiation following combination chemotherapy and second-look laparotomy in the treatment of advanced ovarian cancer]. / Die Ganzabdomenbestrahlung nach Kombinationschemotherapie und Second-look-Laparotomie bei der Behandlung des fortgeschrittenen Ovarialkarzinoms.

From 1980 to 1984 fifty-four patients with advanced ovarian carcinoma after operation and concluding chemotherapy with alkeran (n = 7) or cis-platin/alkeran +/- hexamethylmelamine (n = 47) as well as second-look laparotomy received follow-up radiotherapy either with the moving-strip technique (n = 35) or later the open-field technique (n = 19). 32 patients in CR received radiation therapy. 15 patients in CR are without relapse after undergoing open-field radiation therapy and a mean observation period of 25 months. At this point of time 5 of 17 patients had relapses under the moving-strip radiation treatment. The frequency of the relapses is apparently due to the very long periods of radiation and numerous interruptions in treatment. If residual tumors were present at the begin of ray therapy, a CR could only be achieved in cases where the previous monotherapy was with alkeran.