Partial splenic embolization in the treatment of prolonged thrombocytopenia due to hypersplenism in metastatic cancer patients

Passhak, Maria; Shachar, Shlomit Strulov; Ofer, Amos; Beny, Alexander

doi:10.1007/s00520-018-4192-3

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Yasushi Matsukiyo et al [40] reported that PSE not only promoted the recovery of leukopenia and thrombocytopenia but also induced activation of host immunity in patients with cirrhosis and thrombocytopenia. Maria Passhak et al [41] found that PSE can be considered as a treatment option for hypersplenism-related thrombocytopenia. It was reported by Secil Omer [42] that PSE provided a safe alternative to surgery for treating thrombocytopenia in patients with liver cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Zheng

Liang

et al. 2021

BMC Gastroenterol

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Background To investigate the safety and efficacy of 8Spheres in partial splenic embolization. To explore the possibility of accurate control of splenic embolic volume by quantifying the number of microspheres used during PSE. Method The data of 179 patients who underwent PSE were collected. The patients were divided into two groups: 300–500 um microsphere group (N = 83) and 500–700 um microsphere group (N = 96). The spleen volume before PSE, infarct volume and infarct rate of the spleen after PSE, changes in peripheral blood cells after PSE, postoperative adverse events and incidence of infection were compared between the two groups. Results 300–500 um group vs 500–700 um group: postoperative spleen volume (cm3): 753.82 ± 325.41 vs 568.65 ± 298.16 (P = 0.008); spleen embolization volume (cm3): 525.93 ± 118.29 vs 630.26 ± 109.71 (P = 0.014); spleen embolization rate: 41.1 ± 12.3% vs 52.4 ± 10.1% (P = 0.021). Leukocytes and platelets were significantly increased after PSE in both groups; leukocyte, 1 month: 4.13 ± 0.91 vs 5.08 ± 1.16 (P = 0.026); 3 months: 4.08 ± 1.25 vs 4.83 ± 0.98 (P = 0.022); platelet, 1 month: 125.6 ± 20.3 vs 138.7 ± 18.4 (P = 0.019); 3 months: 121.8 ± 16.9 vs 134.3 ± 20.1 (P = 0.017). Incidence of abdominal pain after PSE, 72 (86.7%) vs 69 (71.9%), P = 0.027. The incidence of other adverse events and infections after PSE was not statistically different. Conclusion PSE with 8Spheres is safe and effective. The use of 500–700 um microsphere for PSE can make the increase of peripheral blood cells more stable. Each vial of 8Spheres corresponds to a certain volume of splenic embolization, so it is possible to achieve quantitative embolization in PSE.

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Section: Discussionmentioning

confidence: 99%

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Zheng

Liang

et al. 2021

BMC Gastroenterol

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“…Also, the PR of 255% following PSE is comparable to the publication by Passhak et al, who reported a PR of about 260%. [ 6 ] Considering the patients with indicated platelet refractoriness before PSE (Patient 3 and Patient 6) an uptake following PC post-PSE was shown. This indicates recovered sensitivity to PC and is reported in the literature following splenectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Usually, parenchymal perfusion during angiographic interventions is assessed on conventional, iodinated contrast angiography by the investigating radiologist with a subjective endpoint of blush reduction. [ 6 , 7 ] This operator-dependent interpretation is highly subjective resulting in inter- and intra-observer variability. [ 22 – 25 ] The potential of 2D-PPBF is to objectify the immediate assessment of perfusion changes during angiographic interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Current endpoints are arbitrary and user-dependent, consisting of visual blush reduction of 50% to 70% in the embolized spleen and an infarction of roughly less than 60 to 80% of the splenic volume. [ 2 , 6 , 7 ] Platelet scintigraphy is reported to predict the response to PSE, but is not available during the intervention. [ 8 ] Peri-interventional parameters to assess and quantify the embolization effect and to estimate post-interventional outcomes are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of perfusion changes using a 2D Parametric Parenchymal Blood Flow technique with automated vessel suppression following partial spleen embolization in patients with hypersplenism and portal hypertension

Meine¹,

Maschke²,

Kirstein

et al. 2021

Medicine

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To evaluate the feasibility and potential value of 2D Parametric Parenchymal Blood Flow (2D-PPBF) for the assessment of perfusion changes following partial spleen embolization (PSE) in a retrospective observational study design. Overall, 12 PSE procedures in 12 patients were included in this study. The outcome of the study was the platelet response (PR), calculated as the percentage increase of platelet count (PLT), following PSE. To quantify perfusion changes using 2D-PPBF, the acquired digital subtraction angiography series were post-processed. A reference region-of-interest (ROI) was placed in the afferent splenic artery and a target ROI was positioned on the embolization territory of the spleen on digital subtraction angiography series pre- and post-embolization. The ratios of the target ROIs to the reference ROIs were calculated for the Wash-In-Rate (WIR), the Time-To-Peak (TTP) and the Area-Under-the-Curve (AUC). Comparisons between pre- and post-embolization data were made using Wilcoxon signed-rank test and Spearman's rank correlation coefficient (r). Afterwards, the study population was divided by the median of the TTP before PSE to analyze its value for the prediction of PR following PSE. Following PSE, PLT increased significantly from 43,000 ± 21,405 platelets/μL to 128,500 ± 66,083 platelets/μL with a PR of 255 ± 243% (P = .003). In the embolized splenic territory, the pre-/post-embolization 2D-PPBF parameter changed significantly: WIRpre-PSE 1.23 ± 2.42/WIRpost-PSE 0.09 ± 0.07; -64 ± 46% (p = 0.04), TTPpre-PSE 4.41 ± 0.99/TTPpost-PSE 5.67 ± 1.52 (P = .041); +34 ± 47% and AUCpost-PSE 0.81 ± 0.85/AUCpost-PSE 0.14 ± 0.08; -71 ± 18% (P = .002). A significant correlation of a 2D-PPBF parameter with the PLT was found for TTPpre-PSE/PLTpre-PSE r = -0.66 (P = .01). Subgroup analysis showed a significantly increased PR for the group with TTPpre-PSE >4.44 compared to the group with TTPpre-PSE ≤4.44 (404 ± 267% versus 107 ± 76%; P = .04). 2D-PPBF is an objective approach to analyze the perfusion reduction of embolized splenic tissue. TTP derived from 2D-PPBF has the potential to predict the extent of PR during PSE.

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“…However, even if the risk-benefit ratio supports PSE in these poor patients who require palliative treatment, the risk of severe complications makes preferable keeping them overnight if symptomatic treatment is needed. On the same way, although no recommendation exists regarding specific precautions against infection with PSE such as pneumococcal vaccination or prophylactic antibiotics, all patients in the present study were treated with these two options to minimize the risk of infectious complications, as those we can see after splenectomy, by analogy SC treatments, which involve oxaliplatin, have been linked to the appearance of distinctive liver lesions, such as hepatic sinusoids blockade, sclerosis of the perisinusoidal space, and veno-occlusive disease, affecting the normal hepatic parenchyma and occasioning portal hypertension (5,(19)(20)(21)(22)(23). Increases in spleen size, platelets splenic sequestration, and development of thrombocytopenia are surrogates of this toxicity.…”

Section: Discussionmentioning

confidence: 99%

Partial splenic embolization with Glubran®2/Lipiodol® mixture for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy

Loffroy¹,

Falvo²,

Nakaï³

et al. 2019

Quant. Imaging Med. Surg

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Background: Partial splenic embolization (PSE) has been used to improve thrombocytopenia related to hypersplenism. The optimal embolic agent is still debated. The purpose of this study was to evaluate the safety, hematologic response and outcomes of PSE with cyanoacrylate glue for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy (SC).Methods: Retrospective single-center observational report of cancer patients with thrombocytopenia related to hypersplenism and requiring SC who underwent PSE with N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) Glubran ® 2 glue between February 2015 and September 2017. All patients were treated under local anesthesia with a Glubran ® 2/Lipiodol ® mixture of 1:5 ratio. They all received empiric antibiotic coverage. Splenic volume and parenchyma infarction rate were evaluated by CT scan within 1 month of PSE. Primary and secondary endpoints of the current study included a platelet count increase >150×10 9 /L and the initiation of SC, respectively. Periprocedural laboratory values and adverse events were recorded.Results: PSE was performed in eight patients (6 males, 2 females; median age, 59 years; range, 33-75 years) for a technical success of 100%. For procedures with adequate follow-up, primary and secondary endpoints were achieved in 100% (7 of 7 patients) and 100% (7 of 7 patients) of patients, respectively. One patient died before follow-up, unrelated to the procedure. Mean splenic infarction post-PSE was 55% (range, 21-70%) on CT scan. For 7 patients with laboratory follow-up, the mean platelet count significantly increased from 74×10 9 /L [range, (62-83) ×10 9 /L] immediately before PSE to a peak level of 272×10 9 /L [range, (161-417) ×10 9 /L] 10 days after PSE (P<0.05). All patients could receive SC after PSE. No non-target glue embolization occurred. All patients experienced a transient and moderate postembolization syndrome. No severe postembolization syndrome occurred. No major complication was reported. The mean overall survival was 7.9 months (range, 0.6-10.4 months) among the 8 patients after PSE. Conclusions: PSE with cyanoacrylate glue is safe and effective in the management of thrombocytopenia related to hypersplenism in cancer patients. It allows sufficient platelet count improvement for administration of SC.

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Partial splenic embolization in the treatment of prolonged thrombocytopenia due to hypersplenism in metastatic cancer patients

Abstract: PSE can be considered as a treatment option for HST.

Cited by 8 publications

References 15 publications

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Evaluation of perfusion changes using a 2D Parametric Parenchymal Blood Flow technique with automated vessel suppression following partial spleen embolization in patients with hypersplenism and portal hypertension

Partial splenic embolization with Glubran®2/Lipiodol® mixture for oncological patients with hypersplenism-related thrombocytopenia requiring systemic chemotherapy

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