Bhatia Shivank S, Venkat Shree, Echenique Ana, Rocha-Lima Caio, Doshi Mehul H, Salsamendi Jason, Barbery Katuska, Narayanan Govindarajan
Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136.
Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136.
J Vasc Interv Radiol. 2015 Aug;26(8):1205-11. doi: 10.1016/j.jvir.2015.04.003. Epub 2015 May 16.
To determine if proximal splenic artery embolization (PSAE) provides a safe and effective alternative to alleviate chemotherapy-induced thrombocytopenia (CIT), allowing patients with cancer to resume chemotherapy regimens.
Thirteen patients (9 men, 4 women; mean age, 63 y) with underlying malignancy (pancreatic adenocarcinoma, n = 6; cholangiocarcinoma, n = 5; other, n = 2) complicated by CIT underwent PSAE. Mean platelet counts were calculated before the initiation of chemotherapy, at the nadir that resulted in discontinuation of chemotherapy before the PSAE procedure, at peak values after the procedure, and at a mean follow-up of 9.2 months. The time to reinitiation of chemotherapy after PSAE was calculated.
Baseline platelet count before initiation of chemotherapy was 162 × 10(9)/L (range, 90-272 × 10(9)/L). The platelet count nadir resulting in cessation of chemotherapy was 45 × 10(9)/L (range, 23-67 × 10(9)/L), and the pre-PSAE platelet count was 88 × 10(9)/L (range, 49-131 × 10(9)/L). The post-PSAE peak platelet count improved significantly (to 209 × 10(9)/L; range, 83-363 × 10(9)/L) compared with the nadir counts and the pre-PSAE counts (P < .01) at a mean short-term follow-up of 35 days (range, 7-91 d). The counts at follow-up to 9.2 months (range, 3-15 mo) were 152 × 10(9)/L (range, 91-241 × 10(9)/L). All patients became eligible to resume chemotherapy. The time to initiation of chemotherapy after PSAE averaged 22 days (range, 4-58 d) in 12 patients; one patient declined chemotherapy.
Proximal splenic artery embolization appears to be safe and effective in alleviating CIT, allowing resumption of systemic chemotherapy. Further studies may help guide patient selection by identifying characteristics that allow a sustained improvement in thrombocytopenia.
确定近端脾动脉栓塞术（PSAE）是否为缓解化疗所致血小板减少症（CIT）提供一种安全有效的替代方法，使癌症患者能够恢复化疗方案。
13例合并CIT的潜在恶性肿瘤患者（9例男性，4例女性；平均年龄63岁）（胰腺腺癌6例；胆管癌5例；其他2例）接受了PSAE。计算化疗开始前、PSAE手术前因化疗中断导致的最低点、手术后峰值以及平均随访9.2个月时的平均血小板计数。计算PSAE后重新开始化疗的时间。
化疗开始前的基线血小板计数为162×10⁹/L（范围90 - 272×10⁹/L）。导致化疗停止的血小板计数最低点为45×10⁹/L（范围23 - 67×10⁹/L），PSAE术前血小板计数为88×10⁹/L（范围49 - 131×10⁹/L）。在平均35天（范围7 - 91天）的短期随访中，与最低点计数和PSAE术前计数相比，PSAE术后峰值血小板计数显著改善（至209×10⁹/L；范围83 - 363×10⁹/L）（P <.01）。随访至9.2个月（范围3 - 15个月）时的计数为152×10⁹/L（范围91 - 241×10⁹/L）。所有患者均有资格恢复化疗。12例患者PSAE后开始化疗的平均时间为22天（范围4 - 58天）；1例患者拒绝化疗。
近端脾动脉栓塞术在缓解CIT方面似乎是安全有效的，能够使全身化疗得以恢复。进一步的研究可能有助于通过识别能使血小板减少症持续改善的特征来指导患者选择。
