Splenic irradiation for the treatment of hypersplenism from congestive splenomegaly

Kenawi, Mohamed; Elghamrawi, Kamal A.; Mohammad, AM; Kenawi, A.; El-Sadek, A. Z.

doi:10.1002/bjs.1800840637

Cited by 12 publications

(11 citation statements)

References 5 publications

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“…In addition, radiotherapy is known to be effective in a large variety of degenerative and hyperproliferative benign conditions [9]. In terms of hypersplenism due to splenic congestion the value of radiotherapy is limited to two case series as illustrated below [10,11]. …”

Section: Discussionmentioning

confidence: 99%

“…Until now, only two case series are reported in the Anglophone literature, which analyse 5 and 8 patients respectively treated with splenic irradiation for symptomatic congestive splenomegaly [10,11]. Both achieved outcomes similar to ours in terms of pain relief (Kenawi: 8 of 8 patients [100%]; Liu: 2 of 2 [100% of the patients with precedent pain]; 3 patients had precedent painless splenomegaly) and increase of platelets (Kenawi: 3 of 8 patients; Liu: 5 of 5 patients) after splenic irradiation.…”

Section: Discussionmentioning

confidence: 99%

“…The mean follow-up of 4 and 19 months respectively was quite short compared to 20 months in our analysis. The applied total dose was significantly higher with 12 Gy in 8 fractions (single doses of 1.5 Gy, five times a week) in the serie of Liu et al [11], while Kenawi et al [10] applied different total doses from 3.0 to 23.0 Gy (mean total dose approximately 12 Gy; single doses ranged from 0.5 to 1.5 Gy). Moreover, in all reported patients there was no correlation between clinical response and change in spleen size observed.…”

Section: Discussionmentioning

confidence: 99%

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Low-dose splenic irradiation in symptomatic congestive splenomegaly: report of five cases with literature data

2014

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BackgroundTo show effectiveness of low-dose splenic irradiation in symptomatic congestive splenomegaly.MethodsFive patients were referred to our department for symptomatic congestive splenomegaly within three years. Primary diseases were autoimmune hepatitis with liver cirrhosis (n = 2), cystic fibrosis (n = 1), granulomatous liver disease (n = 1) and Werlhof disease with liver cirrhosis (n = 1). Mean age was 54 years (range: 36–67). Patients received splenic irradiation with a total dose of 3 Gy (single dose: 0.5 Gy). One patient was re-irradiated after long-term failure with the same treatment schedule.ResultsIn four patients long term relief of splenic pain could be observed during the follow-up time of median 20 (range: 2–36) months. Four patients showed haematological response after irradiation with an increase of erythrocytes, leucocytes and/or platelets. A slightly decrease in spleen size was found in two patients.ConclusionsLow-dose splenic irradiation in symptomatic congestive splenomegaly is feasible and perhaps as effective as in lympho-and myeloproliferative malignancies regarding pain relief and haematological response.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Low-dose splenic irradiation in symptomatic congestive splenomegaly: report of five cases with literature data

2014

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“…In detail, splenic blood flow is increased in patients with cirrhosis and splenomegaly (Merkel et al, 1985;Murata et al, 1996), and spleen size is related to portal vein diameter (Brandt et al, 1989;Kenawi et al, 1997), splenic blood flow (Williams et al, 1968;Alwamark et al, 1982) and portal blood flow (Brandt et al, 1989;Bolognesi et al, 2002). These findings support the hypothesis that, in cirrhosis, spleen hemodynamics is not characterized by passive congestion, but that, on the contrary, the spleen actively congests the portal system, contributing to the maintenance of portal hypertension (Gitlin et al, 1970).…”

Section: Splenic Circulation and Portal Hypertensionmentioning

confidence: 98%

Vasoactive factors and hemodynamic mechanisms in the pathophysiology of portal hypertension in cirrhosis

Gatta

Bolognesi

Merkel

2008

Molecular Aspects of Medicine

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“…This suggests that splenic irradiation may be a potential therapeutic option to manage liver cirrhosis-related thrombocytopenia prior to undergoing anticancer chemotherapy. As there has been only one brief report to date describing the efficacy of splenic irradiation on thrombocytopenia in several patients with liver cirrhosis [18], further studies including larger number of patients should be performed.…”

Section: Discussionmentioning

confidence: 97%

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

Ohkawa

Katayama

Ikezawa

et al. 2010

Clin J Gastroenterol

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Thrombocytopenia is a major complication of liver cirrhosis that often limits the use of anticancer drugs. In this report, we describe a thrombocytopenic patient with liver cirrhosis who developed pancreatic tail cancer and underwent splenic irradiation. Particular emphasis was placed on the impact of irradiation on thrombocytopenia. A 73-year-old male with liver cirrhosis was diagnosed with pancreatic tail cancer infiltrating the splenic hilum by computed tomography (CT) and pancreatic juice cytology. His baseline platelet count was 84 × 10(3)/mm(3). A total of 50 Gy of irradiation to the pancreatic tail and splenic hilum was carried out as local therapy for pancreatic cancer. Splenic irradiation was also expected to reverse liver cirrhosis-related thrombocytopenia, which was making systemic chemotherapy difficult to administer in this patient. One month later, systemic gemcitabine chemotherapy was commenced. At the start of chemotherapy, his platelet count remained at 93 × 10(3)/mm(3), but rose to 246 × 10(3)/mm(3) 2.5 months later, which allowed the administration of chemotherapy without any remarkable hematologic toxicities. Post-irradiation CT revealed a low density area indicating irradiation-induced necrotic tissue that had expanded into the surrounding non-tumorous spleen parenchyma, and which may have impacted positively on the thrombocytopenia. Our case report suggests that splenic irradiation may be a potential therapeutic option for liver cirrhosis-related thrombocytopenia, especially in patients who require systemic chemotherapy for cancer.

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Splenic irradiation for the treatment of hypersplenism from congestive splenomegaly

Cited by 12 publications

References 5 publications

Low-dose splenic irradiation in symptomatic congestive splenomegaly: report of five cases with literature data

Low-dose splenic irradiation in symptomatic congestive splenomegaly: report of five cases with literature data

Vasoactive factors and hemodynamic mechanisms in the pathophysiology of portal hypertension in cirrhosis

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

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