Low‐dose palliative splenic irradiation in haematolymphoid malignancy

Abstract

Patients are treated with palliative splenic irradiation (SI) to relieve pain, volume effects and the clinical consequences of hypersplenism. The case records of 19 patients treated with palliative SI at our centre, from April 2003 to November 2004, were reviewed. Twenty-two courses of SI were identified. The radiation doses delivered ranged from 150 to 800 cGy (median 450 cGy). The fraction sizes ranged from 25 to 100 cGy. Parallel-opposed anteroposterior-posteroanterior portals were the most common field arrangement. The target volume was reduced in 18 out of 22 courses. The percentage of field reduction ranged from 0 to 59.57% (mean 24.82%). Twelve of 14 courses were successful in achieving symptom palliation. Of the six patients who received SI for a combination of splenic symptoms and abnormal blood tests, five had symptomatic palliation but only one patient responded haematologically. Of two patients who were started on palliative SI for abnormal haematology alone, only one responded. In summary, 17 of 20 (85%) courses of SI initiated for symptom control resulted in effective palliation. Only two of eight (25%) courses of SI started for abnormal blood counts produced a desired response. To conclude, SI offers an effective and well-tolerated palliative treatment option.

Radiation exposure of the spleen during 177Lu-DOTATATE treatment and its correlation with haematological toxicity and spleen volume

“…Prior knowledge about radiation exposure of the spleen was obtained from studies of external radiotherapy, where the spleen is irradiated to relieve pain due to splenic enlargement from malignant disease. Side effects from this treatment are described in terms of a decline in haemoglobin (Hb), white blood cell (WBC), and platelet (PLT) counts, which may be due to direct exposure of the blood cells that are physiologically pooled in the spleen, or to a response from haematopoetic cells situated in the spleen [ 20 – 24 ]. Radiation response was also demonstrated in these studies by a desired reduction in the volume of the spleen; as a result of this, effective pain relief is achieved.…”

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].…”