Radiotherapy for one rectal cancer patient with cirrhosis and moderate to severe thrombocytopenia: a case report

Abstract

When patients with cirrhosis and severe thrombocytopenia suffer malignant tumors, there is usually no effective and feasible treatment method due to the high risk of hemorrhage. Herein, we report a case in which radiotherapy was given to a patient with a strong desire for the treatment. The patient was a 66-year-old man with a 13-year history of cirrhosis and a 10-year history of thrombocytopenia, and was diagnosed with locally advanced rectal cancer (LARC; T_4aN₁M₀, stage IIIB). The platelet count before radiotherapy was 32 × 10⁹/L, and the blood coagulation was normal. The severity of thrombocytopenia increased after 2 Gy × 7 fractions pelvic radiation, with platelet counts dropping to 16 × 10⁹/L. Platelet counts failed to return to pre-therapy levels after supporting therapy including recombinant human interleukin 11 subcutaneous injection and platelet transfusion. Although radiotherapy was discontinued eventually, the data presented here represent a valuable resource that can help inform treatment decisions for tumor patients with cirrhosis and thrombocytopenia.

Keywords: liver cirrhosis; radiotherapy; rectal cancer; thrombocytopenia.

Figure 1

CTV-SR (blue), CTV-HR (orange), and GTV (red) on the simulation CT. Notes: (A) The CT layer of the upper edge of CTV-SR; combined CTV-SR included PS and LLN-A. (B) The CT layer of the upper edge (rectosigmoid) of GTV; combined CTV-SR included PS, LLN-A, and M; CTV-HR included M around GTV. (C, D) The CT layers of mid-low (C) and low (D) pelvic; combined CTV-SR included PS, posterior LLN-P, LLN-A, and M; CTV-HR included M around GTV. (E, F) The CT layers of the lower edge of CTV-HR (E) and CTV-SR (F); CTV-SR and CTV-HR included M. Abbreviations: CT, computed tomography; CTV-HR, high-risk clinical target volume; CTV-SR, standard risk clinical target volume; GTV, gross tumor volume; LLN-A, anterior lateral lymph nodes; LLN-P, lateral lymph nodes; M, mesorectum; PS, presacral space.

Figure 2

The changes in complete blood count (RBC, WBC, and PLT) depended on the date and treatments (radiation, IL-11, and PLT infusion). Notes: (A) The changes in RBC, WBC, and PLT depended on the date (days 0–21). (B) 2 Gy radiation on PTV was delivered on days 1–4 and days 7–9. Three milligrams of IL-11 was subcutaneously injected on days 8–12. 1 U PLT was infused on days 10 and 12. (C) The numbers of RBC, WBC, and PLT on different time points. Abbreviations: IL, interleukin; iv, intravenous; PLT, platelet; PTV, planning target volume; RBC, red blood cell; WBC, white blood cell.