Partial splenic embolization to permit continuation of systemic chemotherapy

Area of Science:

• Oncology
• Interventional Radiology

Background:

• Oxaliplatin-based chemotherapy can cause liver lesions, portal hypertension, and thrombocytopenia, potentially interrupting cancer treatment.
• Thrombocytopenia necessitates dose reduction or cessation of chemotherapy, compromising treatment efficacy.

Purpose of the Study:

• To evaluate the efficacy and safety of partial splenic embolization (PSE) in patients with thrombocytopenia impeding systemic chemotherapy.
• To assess the ability of PSE to increase platelet counts and enable the resumption of chemotherapy.

Main Methods:

• A prospective phase II study involving 33 patients with gastrointestinal cancer, primarily colorectal, who underwent PSE.
• 36 PSE procedures were performed, aiming to achieve a platelet count >130 × 10⁹/L.
• Chemotherapy regimens included Folfox, with a mean of 6.4 cycles prior to PSE.

Main Results:

• 94% of patients achieved the primary endpoint of increased platelet count.
• All patients requiring it were able to restart chemotherapy, with a median return time of 14 days.
• No grade 3 or higher adverse events were reported; 50-70% splenic infarction was suggested as optimal.

Conclusions:

• Partial splenic embolization is a safe and effective option for managing chemotherapy-induced thrombocytopenia.
• PSE enables the resumption of systemic chemotherapy, improving cancer treatment outcomes.
• Targeting 50-70% splenic infarction may optimize efficacy while minimizing complications.