Weinmann M, Becker G, Einsele H, Bamberg M
Department of Radiation Oncology, University of Tübingen, Germany.
Strahlenther Onkol. 2001 Feb;177(2):105-11. doi: 10.1007/pl00002384.
Splenic irradiation (SI) is a fairly unknown treatment modality in autoimmune disorders like autoimmune thrombocytopenia (AIT) or autoimmune hemolytic anemia (AIHA), which may provide an effective, low toxic and cost-effective treatment for selected patients.
PATIENTS, MATERIALS AND METHODS: This article reviews the limited experiences on splenic irradiation in autoimmune thrombocytopenia by analyzing the current studies including 71 patients and some preliminary reports on splenic irradiation in autoimmune hemolytic anemia.
In autoimmune thrombocytopenia between 40 and 90% of all patients responded, but most of them relapsed within 4 to 6 months after splenic irradiation. Between 10 and 20% of all patients had a sustained response. The efficacy of splenic irradiation in HIV-associated cases of thrombocytopenia is probably lower than in other forms of autoimmune thrombocytopenia, but especially in this group immunosuppressive drug treatment of autoimmune thrombocytopenia exposes some problems. In autoimmune hemolytic anemia there are some case reports about efficacy of splenic irradiation. Toxicity of splenic irradiation in both diseases was very moderate.
For HIV patients, for elderly patients or patients at high risk for complications following splenectomy splenic irradiation might be a treatment option. Splenic irradiation as preoperative treatment in patients not responding to or not suitable for immunosuppressive drugs prior to splenectomy may be a promising new application of splenic irradiation to reduce adverse effects of splenectomy in thrombocytopenic patients. A further analysis of the biological mechanisms underlying splenic irradiation may help to improve patient selection, to optimize dose concepts and treatment schedules and will improve understanding of radiotherapy as an immunomodulatory treatment modality.
脾照射（SI）在自身免疫性血小板减少症（AIT）或自身免疫性溶血性贫血（AIHA）等自身免疫性疾病中是一种鲜为人知的治疗方式，它可能为特定患者提供有效、低毒且经济高效的治疗。
患者、材料与方法：本文通过分析包括71例患者的当前研究以及关于自身免疫性溶血性贫血脾照射的一些初步报告，回顾了自身免疫性血小板减少症脾照射的有限经验。
在自身免疫性血小板减少症中，40%至90%的患者有反应，但大多数在脾照射后4至6个月内复发。所有患者中有10%至20%有持续反应。脾照射在HIV相关血小板减少症病例中的疗效可能低于其他形式的自身免疫性血小板减少症，但特别是在这组患者中，自身免疫性血小板减少症的免疫抑制药物治疗存在一些问题。在自身免疫性溶血性贫血中有一些关于脾照射疗效的病例报告。两种疾病中脾照射的毒性都非常轻微。
对于HIV患者、老年患者或脾切除术后并发症风险高的患者，脾照射可能是一种治疗选择。在脾切除术前对免疫抑制药物无反应或不适合使用免疫抑制药物的患者中，脾照射作为术前治疗可能是脾照射减少血小板减少症患者脾切除不良反应的一种有前景的新应用。对脾照射潜在生物学机制的进一步分析可能有助于改善患者选择、优化剂量方案和治疗计划，并将增进对放疗作为一种免疫调节治疗方式的理解。
