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Radiotherapy of splenomegaly

A palliative treatment option for a benign phenomenon in malignant diseases

Radiotherapie der Splenomegalie. Eine palliative Behandlungsmodalität eines benignen Symptoms bei hämatoonkologischen Erkrankungen

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Purpose:

Since the 20th century, radiotherapy (RT) has been used for treatment of symptomatic splenomegaly (SM). SM occurs in association with hematologic disorders. The purpose of this analysis was to determine the indication, treatment concepts, and efficiency of RT.

Material and Methods:

Clinical features, treatment concepts, and outcome data during the past 20 years were analyzed. Endpoints were pain relief, symptomatic and hematological response, and treatment-related side effects.

Results:

From 1989–2009, a total of 122 patients received 246 RT courses because of symptomatic SM. Overall 31 patients had chronic myelogenous leukemia (CML), 37 had chronic lymphocytic leukemia (CLL), 23 had osteomyelofibrosis (OMF), 17 had polycythemia vera (PV), 5 had acute myelogenous leukemia, 4 had idiopathic thrombocytopenic purpura (ITP), 3 had non-Hodgkin lymphoma (NHL), and 2 had multiple myeloma (MM). Patients were treated with 60Co gamma rays or 5–15MV photons. The fraction size ranged from 10–200 cGy and the total dose per treatment course from 30–1600 cGy. Significant pain relief was achieved for 74.8% of the RT courses given for splenic pain. At least 50% regression was attained for 77% of the RT courses given for SM. 36 patients died within 2 months due to the terminal nature of their disease. Of the RT courses applied for cytopenia, 73.6% achieved a significant improvement of hematological parameters and reduction of transfusion need. Notable hematologic toxicities were reported < EORTC/RTOG II°.

Conclusion:

The present analysis documents the efficacy of RT. In addition, RT as a palliative treatment option for symptomatic SM should not be forgotten.

Einleitung:

Seit Beginn des 20. Jahrhunderts hat die Radiotherapie (RT) ihren festen Stellenwert in der Behandlung einer symptomatischen Splenomegalie (SM). Die SM tritt bei hämatologischen Erkrankungen auf. Klinisch stehen Kapselschmerz sowie eine Zytopenie im Vordergrund. Die vorliegende Analyse untersucht Indikation, RT-Konzepte und die Effektivität der RT.

Material und Methode:

Patientendaten der letzten 20 Jahre wurden hinsichtlich klinischer Angaben, RT-Konzepte und Ergebnisse evaluiert. Endpunkte waren Schmerzfreiheit, hämatologisches Ansprechen nach RT sowie therapieassoziierte Nebenwirkungen.

Ergebnisse:

Zwischen 1989 und 2009 wurden 122 Patienten (79 Männer und 43 Frauen) mit insgesamt 246 RT-Serien behandelt. Folgende Grunderkrankungen waren Ursache für die Splenomegalie: CML (31), CLL (37), Osteomyelofibrose, (23), Polycyt haemia vera (17), AML (5), idiopathische Thrombozytopenie (4), Non-Hodgkin-Lymphom (3) und Plasmozytom (2) (Tabelle1). Die Behandlung erfolgte am Telekobalttherapiegerät oder am Linearbeschleuniger (5–15 MeV Photonen). Es wurden Einzelreferenzdosen zwischen 0,1–2 Gy und Gesamtreferenzdosen zwischen 3–16 Gy appliziert (Tabelle 2). Bei 74,8% der RT-Serien (74,8%), die aufgrund einer schmerzhaften Splenomegalie durchgeführt wurden, konnte eine Schmerzlinderung erzielt werden. Bei 77% der RT-Serien kam es zu einer Verkleinerung der Milz um bis zu 50% (Abbildung 1). 36 Patienten verstarben weniger als 2 Monaten nach Abschluss der RT im Rahmen der infausten Prognose ihrer Grunderkrankung. Bei 73,6% der RT-Serien kam es zu einer Verbesserung hinsichtlich Thrombozytopenien und die Transfusionsfrequenz nahm ab (Tabelle 3). Es wurden lediglich hämatologische Toxizitäten < II° (EORTC/RTOG) beobachtet.

Schlussfolgerung:

Die vorliegende Analyse belegt die hohe Effektivität der RT bei geringem Nebenwirkungsspektrum. Die RT der symptomatischen Splenomegalie sollte als wirksame palliative Option nicht in Vergessenheit geraten.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Cologne, Cologne, Germany

    Jan Kriz, Rolf-Peter Müller &  Hans Theodor Eich

  2. Department of Radiation Oncology, St. Franziskus Hospital, Bielefeld, Germany

    Oliver Micke

  3. Department of Radiation Oncology, Medical School Hannover, Hannover, Germany

    Frank Bruns

  4. Department of Radiology and Radiation Oncology, Clemens Hospital Münster, Münster, Germany

    Uwe Haverkamp

  5. Department of Radiation Oncology, Hospital Lippe, Lippe, Germany

    Ralph Mücke & Ulrich Schäfer

  6. Center of Radiotherapy, Hamburg, Germany

    Heinrich Seegenschmiedt

  7. Department of Radiation Oncology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Hans Theodor Eich

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  1. Jan Kriz
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  2. Oliver Micke
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  9. Hans Theodor Eich
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Correspondence to Hans Theodor Eich.

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Kriz, J., Micke, O., Bruns, F. et al. Radiotherapy of splenomegaly. Strahlenther Onkol 187, 221–224 (2011). https://doi.org/10.1007/s00066-011-2252-4

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  • DOI: https://doi.org/10.1007/s00066-011-2252-4

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