Splenic irradiation for splenomegaly: A systematic review

Area of Science:

• Hematology
• Radiation Oncology
• Palliative Care

Background:

• Splenic irradiation (SI) is a palliative treatment for symptomatic splenomegaly in hematologic malignancies.
• Symptoms include pain, early satiety, and pancytopenia due to spleen sequestration.
• Effective management of splenomegaly is crucial for improving patient quality of life.

Purpose of the Study:

• To review the literature on splenic irradiation for hematologic malignancies.
• To evaluate patient selection, technique, efficacy, and toxicities of SI.
• To provide evidence-based insights for clinical practice.

Main Methods:

• Systematic literature review using PICOS/PRISMA guidelines.
• Analysis of 27 articles encompassing 766 SI courses in 486 patients (1960-2016).
• Focus on chronic lymphocytic leukemia and myeloproliferative disorders.

Main Results:

• 85-90% partial or complete response rate for symptoms and lab abnormalities.
• No correlation found between radiation dose and response duration or efficacy.
• Grade 3-4 toxicity in 22% of courses; Grade 5 toxicity in 0.7%, primarily sepsis or hemorrhage, not directly SI-caused.

Conclusions:

• Splenic irradiation is a safe and effective palliative treatment for symptomatic splenomegaly.
• Lower radiation doses may achieve similar efficacy to higher doses.
• SI significantly improves symptoms and laboratory abnormalities in patients with hematologic disorders.