Weinmann M, Becker G, Einsele H, Bamberg M
Department of Radiation Oncology, University of Tübingen, Hoppe-Seylerstrasse 3, 72076 Tübingen, Germany.
Radiother Oncol. 2001 Mar;58(3):235-46. doi: 10.1016/s0167-8140(00)00316-9.
Splenic irradiation (SI) was the first efficient treatment for chronic leukaemia, but with the emergence of effective drugs its use has been more and more restricted to advanced cases presenting with splenomegaly. But in selected patients who are not responsive or not suitable to drug treatment, SI may offer still an effective, low toxic and cost-effective palliative modality. Eight studies of SI in chronic lymphatic leukaemia (CLL) including 198 patients, six reports about SI in prolymphocytic leukaemia (PLL), including 18 patients, one study and six case reports about SI in hairy cell leukaemia (HCL) and nine studies about SI in myeloproliferative disorders has been analyzed. In CLL, symptoms of splenomegaly have been improved in 50-87% of all patients with overall doses between 4 and 10 Gy in mostly 1-Gy fractions. PLL seems to be more resistant to SI with a median response rate of 66%. Casuistic reports described also efficacy of SI in HCL patients using similar radiation schedules. Symptomatic relief is also provided by SI in myeloproliferative disorders using lower overall doses between 1 and 9 Gy with small single fractions of 0.25 Gy (median). Acute toxicity was low in lymphoid disorders, but higher in myeloproliferative disorders with severe cytopenia in 10-30% of all cases, indicating the need for a cautious fractionation schedule. Interestingly, even complete systemic remissions after SI in all types of lymphoproliferative disorders have been described. Different mechanisms underlying SI such as direct cell kill, immune modulation via changes in lymphocyte subsets or cytokine induction or "radiotherapeutic" splenectomy with high doses are discussed.
脾照射（SI）是慢性白血病的首个有效治疗方法，但随着有效药物的出现，其应用越来越局限于出现脾肿大的晚期病例。但在某些对药物治疗无反应或不适合药物治疗的患者中，SI可能仍是一种有效、低毒且具有成本效益的姑息治疗方式。分析了八项关于慢性淋巴细胞白血病（CLL）的脾照射研究（包括198例患者）、六项关于幼淋巴细胞白血病（PLL）的脾照射报告（包括18例患者）、一项关于毛细胞白血病（HCL）的脾照射研究及六项病例报告以及九项关于骨髓增殖性疾病的脾照射研究。在CLL中，50%至87%的患者脾肿大症状得到改善，总剂量在4至10 Gy之间，大多采用1 Gy的分次剂量。PLL似乎对SI更具抗性，中位缓解率为66%。个案报告也描述了采用类似放疗方案时SI对HCL患者的疗效。在骨髓增殖性疾病中，采用较低的总剂量（1至9 Gy）和小的单次剂量0.25 Gy（中位剂量）进行脾照射也能缓解症状。在淋巴系统疾病中急性毒性较低，但在骨髓增殖性疾病中较高，所有病例中有10%至30%出现严重血细胞减少，这表明需要谨慎制定分次放疗方案。有趣的是，甚至在所有类型的淋巴增殖性疾病中都有脾照射后出现完全全身缓解的描述。文中讨论了脾照射的不同潜在机制，如直接细胞杀伤、通过淋巴细胞亚群变化或细胞因子诱导进行免疫调节或高剂量的“放射治疗性”脾切除。
