Abstract
Painful splenomegaly has a clinical presentation that is often associated with myeloproliferative disorders, such as acute or chronic lymphoblastic or myelogenous leukemia. In these situations low-dose radiotherapy is effective in reducing the splenomegaly and relieving pain. The potential benefi t of radiotherapy for cardiogenic splenomegaly is less well established. The present report discusses a case in which radiotherapy was employed to benefi t a patient with Eisenmenger’sassociated painful splenomegaly. Because of the patient’s high anesthesia risk, palliative surgical splenectomy was not feasible. The patient underwent three-dimensional conformal treatment planning, and a total of 42.5 Gy at 2.5 Gy per fraction was prescribed to the spleen. At 4 months following radiotherapy completion, the patient reported durable pain relief and no untoward small bowel effects; moreover, there was a 43% reduction in splenic volume on follow-up CT. Although there have been previous reports of hematological and myeloproliferative-associated splenomegaly that have been treated with a lower dose per fraction and lower total dose radiotherapy, we advocate the use of 2.0–2.5 Gy per fraction to a total dose approaching 40 Gy for adequate duration of response when treating cardiogenic-associated painful splenomegaly in patients for whom surgical splenectomy cannot be performed.
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References
Vongpatanasin W, Brickner ME, Hillis LD, Lange RA. The Eisenmenger syndrome in adults. Ann Intern Med 1998;128:745–755.
Child JS, Friedman WF. Congenital heart disease in the adult. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s principles of internal medicine, 16th edition. New York: McGraw-Hill; 2005 p. 1381.
McFarland JT, Kuzma C, Millard FE, Johnstone PA. Palliative irradiation of the spleen. Am J Clin Oncol 2003;26:178–183.
Senn N. Case of spleno-medullary leukemia successfully treated by use of roentgen ray. Med Rec N Y 1903;63:281–282.
Mod H, Prasiko G, Jha AK, Chaurasia PP, Srivastava R. Radiotherapy for splenomegaly. J Nepal Med Assoc 2005;44:97–99.
Coughlin C, Papac R, Roberts KB. Leukemia. In: Perez CA, Brady LW, Halperin EC, Schmidt-Ullrich RK, editors. Principles and practice of radiation oncology, 4th edition. Philadelphia: Lippincott Raven; 2004 p. 2142–2143.
Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991;21:109–122.
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Osorio, J.I., Watkins, J.M., Strange, C. et al. Radiation therapy for palliation of Eisenmenger’s syndrome-associated painful splenomegaly. Radiat Med 26, 84–87 (2008). https://doi.org/10.1007/s11604-007-0194-7
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DOI: https://doi.org/10.1007/s11604-007-0194-7