title: Adaptive splenic radiotherapy for symptomatic splenomegaly management in myeloproliferative disorders.
abstract: OBJECTIVE
  Symptomatic, massive splenomegaly is a debilitating complication of myeloproliferative disorders. In the study, we evaluated the use of a contemporary, individualized radiotherapeutic approach for splenic irradiation, including 3-dimensional computed tomography-based treatment planning, individualized treatment margins based on splenic motion assessment, online setup verification with volumetric image guidance at each fraction, and adaptive radiation treatment planning to account for changes in splenic size during the fractionated radiotherapy course.
  
  
  METHODS
  Between December 2008 and January 2014, 18 patients (13 males, 5 females) with myeloproliferative disorders referred to Gulhane Military Medical Academy Radiation Oncology Department underwent 22 courses of splenic irradiation using 3-dimensional computed tomography-based treatment planning and volumetric image guidance for palliation of symptomatic splenomegaly.
  
  
  RESULTS
  Median age was 64 years (range 28-79). Significant pain relief was achieved in 20 of the 22 splenic irradiation courses (90.9%). Improvement in hematological parameters was achieved in 8 of the 11 splenic irradiation courses applied for cytopenia (72.7%). At least a 50% reduction in splenic size was achieved in 18 of the 22 splenic irradiation courses (81.8%). Toxicity was manageable with supportive treatment including antiemetics and platelet or red blood cell transfusions.
  
  
  CONCLUSIONS
  Splenic irradiation with a contemporary radiotherapeutic approach offers safe and effective palliation of symptomatic splenomegaly in myeloproliferative disorders.
authors.affiliation: Department of Radiation Oncology, Gulhane Military Medical Academy, Ankara - Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Sager
authors.forename: Murat
authors.initials: M
authors.lastname: Beyzadeoglu
authors.forename: Ferrat
authors.initials: F
authors.lastname: Dincoglan
authors.forename: Selcuk
authors.initials: S
authors.lastname: Demiral
authors.forename: Bora
authors.initials: B
authors.lastname: Uysal
authors.forename: Hakan
authors.initials: H
authors.lastname: Gamsiz
authors.forename: Mustafa
authors.initials: M
authors.lastname: Akin
authors.forename: Esin
authors.initials: E
authors.lastname: Gundem
authors.forename: Bahar
authors.initials: B
authors.lastname: Dirican
mesh_terms: D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009196:Myeloproliferative Disorders / Q000150:complications; D010166:Palliative Care / Q000379:methods*; D057285:Precision Medicine; D055728:Primary Myelofibrosis / Q000150:complications*; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D013163:Splenomegaly / Q000209:etiology* / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014421:Turkey