Palliative splenic irradiation for symptomatic splenomegaly in non-Hodgkin lymphoma

Abstract

Introduction and aimsSplenic marginal zone lymphoma, an uncommon subtype of non-Hodgkin lymphoma (NHL), is usually present with symptomatic splenomegaly. Although splenectomy has long been considered the first-line therapy in symptomatic or cytopenic patients, it can lead to significant morbidity and mortality. Splenic irradiation is an option for patients who have a poor response to systemic therapy and/or are not surgical candidates. In this paper, we present a case report of a patient who received splenic radiotherapy for symptomatic splenomegaly.MethodsAn 85-year-old Caucasian man with a 4 year history of low-grade NHL presented with progressive pancytopenia, significant weight loss and symptomatic splenomegaly (abdominal discomfort, sense of fullness and limitation of mobility due to spleen size). The patient refused splenectomy and, in December 2017, was referred to palliative splenic radiotherapy. He was initially treated with five fractions of one Grey (Gy) in order to evaluate clinical and haematology response. After that, 1.5 Gy daily, 5 days a week for 3 weeks. 3D conformal radiotherapy, multiple fields and mixed energy (6 and 15 Mv) were used.ResultsRadiotherapy allowed significant splenic reduction to almost half the size, resolving abdominal discomfort and improving quality of life. There was no decline of haemoglobin, leukocytes and platelet counts; in fact, there was a marginal increase.ConclusionPalliative splenic irradiation was well tolerated confirming that it is a safe treatment option for palliation of symptomatic splenomegaly. Thereby, splenic irradiation should be strongly considered in the management of symptomatic splenomegaly, for selected patients who are refractory to or unsuitable for other options or when the patient refuses other treatments.

Guideline for the diagnosis and management of marginal zone lymphomas: A British Society of Haematology Guideline

“…A higher 24 Gy dose may provide more durable control but carries a greater risk of cytopenias during and after RT. [151][152][153] A full blood count should be monitored weekly during treatment.…”

“…For patients unfit for systemic therapy or splenectomy, RT can provide rapid, effective palliation leading to a significant reduction of splenic size and pain, even with very low dose schedules of 4–10 Gy. A higher 24 Gy dose may provide more durable control but carries a greater risk of cytopenias during and after RT 151–153 . A full blood count should be monitored weekly during treatment.…”

Diagnóstico Histopatológico e Imuno-histoquímico de Linfoma de Baço com Apresentação Clínica Atípica: Relato de Caso

“…O paciente fez, em seguida, quatro ciclos de quimioterapia sob o esquema farmacológico R-CHOP. Desde 2002, esse esquema terapêutico vem sendo utilizado no tratamento de linfomas LNH de fenótipo B, trazendo aproximadamente 20% de melhora no prognóstico 10 . Hoje, o paciente apresenta-se em remissão completa e segue com acompanhamento em hospital de referência.…”

Protective effect of acute splenic irradiation in rats with traumatic brain injury

“…Previous research has found that spleen-derived immune cells are highly sensitive to radiation, but for a long time, the clinical application of spleen irradiation has been limited. Currently, it is mainly used for the treatment of malignant tumors [5,6], hematological diseases [7][8][9], spleen metastasis [10] and graft rejection [11]. Moreover, most animal experimental studies on spleen irradiation have been based on whole-body irradiation of animals [12][13][14] or irradiation of isolated cells, whereas few specific studies on in-vivo spleen irradiation have been conducted.…”