Oliveira Liliana Castro, Fardilha Carlos, Louro Manuel, Pinheiro Carlos, Sousa Abílio, Marques Herlander, Costa Paulo
Department of Oncology, Hospital da Senhora da Oliveira, Guimarães, Portugal.
Department of Radiation Oncology, Hospital de Braga, Braga, Portugal.
Ecancermedicalscience. 2018 Dec 13;12:887. doi: 10.3332/ecancer.2018.887. eCollection 2018.
Splenic marginal zone lymphoma, an uncommon subtype of non-Hodgkin lymphoma (NHL), is usually present with symptomatic splenomegaly. Although splenectomy has long been considered the first-line therapy in symptomatic or cytopenic patients, it can lead to significant morbidity and mortality. Splenic irradiation is an option for patients who have a poor response to systemic therapy and/or are not surgical candidates. In this paper, we present a case report of a patient who received splenic radiotherapy for symptomatic splenomegaly.
An 85-year-old Caucasian man with a 4 year history of low-grade NHL presented with progressive pancytopenia, significant weight loss and symptomatic splenomegaly (abdominal discomfort, sense of fullness and limitation of mobility due to spleen size). The patient refused splenectomy and, in December 2017, was referred to palliative splenic radiotherapy. He was initially treated with five fractions of one Grey (Gy) in order to evaluate clinical and haematology response. After that, 1.5 Gy daily, 5 days a week for 3 weeks. 3D conformal radiotherapy, multiple fields and mixed energy (6 and 15 Mv) were used.
Radiotherapy allowed significant splenic reduction to almost half the size, resolving abdominal discomfort and improving quality of life. There was no decline of haemoglobin, leukocytes and platelet counts; in fact, there was a marginal increase.
Palliative splenic irradiation was well tolerated confirming that it is a safe treatment option for palliation of symptomatic splenomegaly. Thereby, splenic irradiation should be strongly considered in the management of symptomatic splenomegaly, for selected patients who are refractory to or unsuitable for other options or when the patient refuses other treatments.
脾边缘区淋巴瘤是非霍奇金淋巴瘤（NHL）的一种罕见亚型，通常表现为有症状的脾肿大。尽管脾切除术长期以来一直被认为是有症状或血细胞减少患者的一线治疗方法，但它可能导致显著的发病率和死亡率。脾照射是对全身治疗反应不佳和/或不适合手术的患者的一种选择。在本文中，我们报告了一例因有症状的脾肿大接受脾放疗的患者。
一名85岁的白人男性，有4年低度NHL病史，出现进行性全血细胞减少、显著体重减轻和有症状的脾肿大（腹部不适、饱腹感以及因脾脏大小导致的活动受限）。患者拒绝脾切除术，并于2017年12月接受姑息性脾放疗。最初给予5次每次1格雷（Gy）的照射，以评估临床和血液学反应。之后，每周5天，每天1.5 Gy，共3周。采用3D适形放疗，多野和混合能量（6和15兆伏）。
放疗使脾脏显著缩小至几乎原来大小的一半，缓解了腹部不适，改善了生活质量。血红蛋白、白细胞和血小板计数没有下降；事实上，还有轻微增加。
姑息性脾照射耐受性良好，证实它是缓解有症状脾肿大的一种安全治疗选择。因此，对于有症状的脾肿大的治疗，对于那些对其他选择难治或不适合其他选择的特定患者，或者当患者拒绝其他治疗时，应强烈考虑脾照射。
