Partial splenic embolization for cancer patients with thrombocytopenia requiring systemic chemotherapy

Abstract

BACKGROUND. Partial splenic embolization (PSE) has been used to improve hematologic parameters related to hypersplenism. The purpose of this study was to review our institutional experience with PSE for cancer patients with thrombocytopenia because of splenic sequestration precluding the administration of systemic therapy (ST). METHODS. A retrospective review of cancer patients undergoing PSE was undertaken. Twenty‐eight patients underwent PSE to correct thrombocytopenia to facilitate the initiation or resumption of ST. Primary and secondary endpoints of the current study included a platelet count increase > 150 K/UL and the initiation of ST, respectively. Periprocedural laboratory values and adverse events were recorded. RESULTS. Thirty PSEs were performed in 28 patients. Two patients underwent repeat PSE because of recurrent thrombocytopenia after the successful initiation of ST. For procedures with adequate follow‐up, primary and secondary endpoints were achieved in 96.3% (26 of 27 patients) and 95.7% (22 of 23 patients) of patients, respectively. The mean platelet count was 81 K/UL immediately before PSE and peaked at 293 K/UL after PSE. For 23 patients with frequent laboratory follow‐up, the mean time to a platelet count > 150 K/UL was 10 days. The mean hospital stay was 4.5 days. Postprocedure abdominal pain occurred in all patients. Fever was documented in 16 patients and pulmonary consolidation/atelectasis or effusion was documented in 10 patients; 9 patients received empiric antibiotic coverage. The median overall survival was 9.40 months (95% confidence interval, 8.2–10.7 months) among the 28 patients after PSE. CONCLUSIONS. PSE is a safe and effective means of managing thrombocytopenia secondary to hypersplenism to facilitate the administration of ST in patients with cancer. Cancer 2008. © 2008 American Cancer Society.

Simultaneous Combined Balloon-occluded Retrograde Transvenous Obliteration and Partial Splenic Embolization for Portosystemic Shunts

“…PSE also increases platelet count, making it possible to administer interferon therapy (27,28) or chemotherapy (29) and to perform invasive procedures (30). These findings provide a rational basis to support the addition of PSE before B-RTO.…”

Thrombocytopenia due to hypersplenism in oncological disease: Partial splenic embolization during palliative treatment

“…This may be present as thrombocytopenia and/or leukocytopenia. In certain patients with severe peripheral cytopenia, treatments such as interferon [5], antiangiogenics [6], and major surgery [7] can be contra-indicated and can, therefore, be the cause of a loss of chance for patients. Moreover, life-threatening spontaneous episodes of bleeding may also occur in these patients who are already in poor condition.…”

Prior splenic irradiation reduces hematologic adverse events during chemotherapy in pancreatic tail cancer: a report of a patient with liver cirrhosis

“…Both procedures have been reported to benefit anticancer and antiviral therapies in thrombocytopenic patients with liver cirrhosis. PSE has been reported to be effective in facilitating chemotherapy administration in cancer patients with thrombocytopenia [11]. Splenectomy and PSE prior to the pegylated interferon plus ribavirin therapy have also been shown to be helpful for the achievement of antiviral therapy in patients with chronic hepatitis C virus infection having thrombocytopenia [12][13][14][15].…”