Objectives: To evaluate the effectiveness of low doses of radiation therapy for symptomatic splenomegaly in malignant and benign diseases. Patients and methods: 5 patients with symptomatic splenomegaly were treated with low doses of radiation in our centre (January 2008-December 2016). 4/5 patients had malignant neoplasia (acute myeloid leukemia, non Hogdkin lymphoma and prolymphocytic B cell leukemia) and splenomegaly was caused by extramedullary hematopoiesis. 1/5 patient had benign disease (HBV liver cirrhosis) and splenomegaly was caused by vascular ectasia. Median age was 73 years (range 61-86 years). There were 4 females and 1 male. These patients had exclusively splenic pain or abdominal discomfort in 20%, exclusively cytopenias 40% and both 40%. Patients needed radiation therapy for symptomatic control. Dose per fraction was 0.5 Gy every two days; total dose initially prescribed 10 Gy. IGRT were performed in all patients to ensure an appropriate position and to adapt the treatment volume to the changes in the spleen volume along the treatment. Median craneocaudal length size of the spleen was more than 26 cm (range 15.2-34.9 cm). Results: Median radiation doses were 4.85 Gy (range 2.5-10). Median craneocaudal spleen size reduction was 4.6 cm (0-8 cm). Splenic pain and abdominal disturbances improved in all patients. Median increase of haemoglobin and platelets levels was 1.6 mg/dl and 27.950 cells respectively in the first week after the end of radiotherapy. One patient had to interrupt her treatment due to grade II neutropenia. No other toxicities were described. With a median follow-up of 39 months (16-89 months), only one recurrence was described at 24 months and consisted of thrombocytopenia. The patient received a second course of radiotherapy with excellent response. Conclusion: Low doses of radiation therapy for treatment of symptomatic splenomegaly were effective, with a low rate of side effects. Splenic pain and abdominal discomfort completely improved and cytopenias rised to secure levels.

HighlightsIsolated chloroma should be considered as a systemic disease.Consolidation radiotherapy has been related with prolonged failure free survival.Excellent local control of chloroma is achieved with low-dose radiotherapy.

Purpose To report vaginal cuff brachytherapy (VCB) dosimetry parameters and clinical outcomes of patients with localized endometrial cancer treated with adjuvant high-dose-rate (HDR) brachytherapy using a cobalt-60 ( 60 Co) source. Material and methods Between 2011 and 2017, we identified patients with endometrial cancer treated with surgery and adjuvant VCB. Dosimetry variables analyzed included D 2cc , D 1cc , and D 0.1cc for organs at risk (OARs) and distance from cylinder surface to 150% and 200% isodose line in vaginal mucosa. Local relapse (LR), regional relapse (RR), distant metastasis (DM), progression-free survival (PFS), and overall survival (OS) were analyzed using Kaplan-Meier, and log-rank test was applied to assess differences between groups. Toxicity evaluation was tested for possible cross-correlation within dosimetric parameters using Pearson r test and stepwise multivariate linear regression. Results We identified 93 suitable patients. Mean age at diagnosis was 66 years (range, 45-85 years). Most patients had endometrioid adenocarcinoma (61.3%), followed by papillary-serous carcinoma (11.8%). 71% of patients presented with FIGO stage I (35.5% IA and 35.5% IB), 11.8% were stage II, and 17.2% were stage III. Adjuvant external beam radiotherapy (EBRT) (range, 46-50.4 Gy) was used in 53.8% of patients, and adjuvant chemotherapy in 38.7%. Median follow-up was 39 months (range, 5-84 months). Three-year OS and PFS were 87.5% and 85.5%, respectively. LR was seen in 2.2% of cases, RR in 7.5%, and DM in 12.9%. Mean rectum D 2cc /D 0.1cc were 88.1% and 116%, and mean bladder D 2cc /D 0.1cc were 79.2% and 103.2%, respectively. The most common acute toxicity was vaginal mucositis (8.9% ≥ G2), and the most frequent chronic toxicity was vaginal stenosis (25.3% ≥ G1). Conclusions Adjuvant high-dose-rate VCB with 60 Co source for patients with endometrial cancer is well tolerated, with clinical and toxicity outcomes comparable to those reported with iridium-192 ( 192 Ir) source.

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