Short-Time Splenic Irradiation for Splenomegaly

Abstract

Background: Splenic irradiation is routinely used in the supportive treatment of lymphoepithelial and hemopoietic diseases associated with splenomegaly. A new short-time irradiation schedule with conventional dosage (Group A: 2 Gy/fract.) was compared retrospectively with low-dose prolonged treatment schedules (Group B: ≤ 1 Gy/fract.) to establish its tolerance and its efficacy in terms of relieving splenomegaly-associated symptoms. Patients and Method: Between 12/1996 and 3/2002 49 patients (6 with CLL, 14 with CML, 6 with NHL, 16 with MPD, 6 with OMF and 1 with AML) underwent 85 treatment courses (13 courses low-dose prolonged treatment and 72 courses short-time treatment).The spleens had been exposed to pretreatment doses of 3–70 Gy (mean 20.75 Gy). Splenic size was 12–35 cm (mean 22.76 cm). One treatment was done with 60Co. 9–20 MeV electron beams were used in 23 treatments and 6 MV photons in 61 treatments. Blood counts were monitored daily. Clinical improvement (pain relief, improvement of splenomegaly-associated symptoms), spleen volume reduction and effects on blood counts were evaluated and documented at the end of the treatment. Results: Of the 85 treated patients, 55 (Group A: 47/72, Group B: 8/13) showed a > 10% reduction of spleen volume and 62 (Group A: 57/72, Group B: 5/13) clinical improvement. 15 of 49 patients underwent multiple irradiation (2–8 courses) without clinical or hematologic complications. The intervals between the courses were 2–19 months. Rapid response in terms of reduction in splenic size in 23 patients permitted field reduction during treatment. Significant hematologic abnormalities were absent throughout. Conclusion: The short-time treatment schedule ensured a rapid response with relief of pain and improvement of gastrointestinal and pulmonary symptoms at an overall treatment time shorter than that of low-dose prolonged treatment schedules. No differences in terms of hematologic abnormalities were found between single doses of 2 Gy and ≤ 1 Gy.

Acute Splenic Irradiation Reduces Brain Injury in the Rat Focal Ischemic Stroke Model

“…Splenic irradiation is highly effective in reducing spleen size in patients with lymphoepithelial and hemopoietic diseases associated with splenomegaly [18]. Spleen-derived immunologic cells are known to be very sensitive to irradiation and undergo apoptosis after relatively low doses of a few Gy [19].…”

Radiotherapy of splenomegaly

“…Although there are only few retrospective studies with low numbers of treated patients for SI available [18,20], we compared our findings with results reported in the literature. Considering that hematologic disorders, such as CLL, CML, and AML, are accompanied by SM and due to the fact that SM is often resistant to chemotherapy, SI is used as a palliative treatment option.…”

“…The spleen fills the left hemiabdomen and can extend into the pelvis. This occurs in more than a third of patients and is thought to be due to extramedullary hematopoesis [1,2,5,10,13,17,18,20,21].…”