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Supplementary Material for: Bone Marrow-Sparing Intensity-Modulated Radiotherapy (IMRT) for Neo-Adjuvant Therapy of Inoperable Cervical Cancer in a Patient with Severe Thrombocytopenia

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posted on 19.03.2010, 00:00 by Simeonova A., Abo-Madyan Y., Ströbel P., Kleine W., Schwarzbach M., Fleckenstein K., Wenz F.
Background: Therapy possibilities are limited in patients with cervix carcinoma and thrombocytopenia. Case Report: 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. Conclusion: The clinical implementation of IMRT may potentially improve the therapeutic outcome of patients with cervix cancer, allowing dose escalation without increasing normal-tissue toxicity.