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Case Reports in Medicine
Volume 2010, Article ID 321835, 4 pages
http://dx.doi.org/10.1155/2010/321835
Case Report

Intensity-Modulated Radiotherapy for a Rendu-Osler-Weber Disease Patient with Recurrent Severe Epistaxis: A Case Report

1Department of Radiation Oncology, Ludwig-Maximilians-University München, Marchioninistr. 15, 81377 München, Germany
2Department of Otolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland
3Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland

Received 20 December 2009; Accepted 25 February 2010

Academic Editor: Michael J. Eble

Copyright © 2010 Maximilian Niyazi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present a case of a Rendu-Osler-Weber disease patient with recurrent life threatening epistaxis demanding multiple blood transfusions despite of repetitive endoscopic laser and electrocoagulations, endovascular embolisation, septodermoplasty, and long-term intranasal dressings. As alternative treatment modalities repeatedly failed and the patient became almost permanently dependent on nasal dressing, we performed a highly conformal intensity-modulated radiotherapy of the nasal cavity; a total dose of 50 Gy in 2 Gy single fractions was applied. The therapy was very well tolerated, no acute toxicities occurred. Two weeks after the last radiation dose had been applied, the nasal dressing could be removed without problems. Endoscopical control revealed an almost avascular white mucosa without any trace of bleeding spots; previously existing hemangiomas and crusts had disappeared. After a 1-year-follow up, the patient had no significant recurrent epistaxis.