de la Pinta Carolina, Fernández Lizarbe Eva, Montero Luis Ángel, Domínguez Rullán José Antonio, Sancho García Sonsoles
Ramón y Cajal University Hospital, Madrid, Spain.
HM Madrid, Spain.
Tech Innov Patient Support Radiat Oncol. 2017 Sep 6;3-4:23-29. doi: 10.1016/j.tipsro.2017.08.002. eCollection 2017 Sep-Dec.
To evaluate the effectiveness of low doses of radiation therapy for symptomatic splenomegaly in malignant and benign diseases.
5 patients with symptomatic splenomegaly were treated with low doses of radiation in our centre (January 2008-December 2016). 4/5 patients had malignant neoplasia (acute myeloid leukemia, non Hogdkin lymphoma and prolymphocytic B cell leukemia) and splenomegaly was caused by extramedullary hematopoiesis. 1/5 patient had benign disease (HBV liver cirrhosis) and splenomegaly was caused by vascular ectasia. Median age was 73 years (range 61-86 years). There were 4 females and 1 male. These patients had exclusively splenic pain or abdominal discomfort in 20%, exclusively cytopenias 40% and both 40%. Patients needed radiation therapy for symptomatic control. Dose per fraction was 0.5 Gy every two days; total dose initially prescribed 10 Gy. IGRT were performed in all patients to ensure an appropriate position and to adapt the treatment volume to the changes in the spleen volume along the treatment. Median craneocaudal length size of the spleen was more than 26 cm (range 15.2-34.9 cm).
Median radiation doses were 4.85 Gy (range 2.5-10). Median craneocaudal spleen size reduction was 4.6 cm (0-8 cm). Splenic pain and abdominal disturbances improved in all patients. Median increase of haemoglobin and platelets levels was 1.6 mg/dl and 27.950 cells respectively in the first week after the end of radiotherapy.One patient had to interrupt her treatment due to grade II neutropenia. No other toxicities were described. With a median follow-up of 39 months (16-89 months), only one recurrence was described at 24 months and consisted of thrombocytopenia. The patient received a second course of radiotherapy with excellent response.
Low doses of radiation therapy for treatment of symptomatic splenomegaly were effective, with a low rate of side effects. Splenic pain and abdominal discomfort completely improved and cytopenias rised to secure levels.
评估低剂量放射治疗对恶性和良性疾病所致有症状脾肿大的有效性。
2008年1月至2016年12月期间，我们中心对5例有症状脾肿大患者进行了低剂量放射治疗。5例患者中4例患有恶性肿瘤（急性髓系白血病、非霍奇金淋巴瘤和前淋巴细胞B细胞白血病），脾肿大由髓外造血引起。1例患者患有良性疾病（乙肝肝硬化），脾肿大由血管扩张引起。中位年龄为73岁（范围61 - 86岁）。有4名女性和1名男性。这些患者中，20%仅有脾区疼痛或腹部不适，40%仅有血细胞减少，40%两者都有。患者因症状控制需要进行放射治疗。每次分割剂量为每两天0.5 Gy；初始处方总剂量为10 Gy。所有患者均进行了图像引导放射治疗（IGRT），以确保合适的体位，并使治疗体积适应脾脏体积在治疗过程中的变化。脾脏的中位头尾径长度超过26 cm（范围15.2 - 34.9 cm）。
中位放射剂量为4.85 Gy（范围2.5 - 10）。脾脏中位头尾径缩小4.6 cm（范围0 - 8 cm）。所有患者的脾区疼痛和腹部不适均有改善。放疗结束后第一周，血红蛋白和血小板水平的中位增加值分别为1.6 mg/dl和27950个细胞。1例患者因II级中性粒细胞减少不得不中断治疗。未描述其他毒性反应。中位随访39个月（范围16 - 89个月），仅1例在24个月时出现复发，表现为血小板减少。该患者接受了第二疗程放疗，反应良好。
低剂量放射治疗有症状脾肿大有效，副作用发生率低。脾区疼痛和腹部不适完全改善，血细胞减少升至安全水平。
