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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.