Partial splenic embolization to permit continuation of systemic chemotherapy.
Systemic chemotherapy treatments, commonly those that comprise oxaliplatin, have been linked to the appearance of distinctive liver lesions that evolves to portal hypertension, spleen enlargement, platelets sequestration, and thrombocytopenia. This outcome can interrupt treatment or force dosage reduction, decreasing efficiency of cancer therapy. We conducted a prospective phase II study for the evaluation of partial splenic embolization in patients with thrombocytopenia that impeded systemic chemotherapy continuation. From August 2014 through July 2015, 33 patients underwent partial splenic embolization to increase platelets count and allow their return to treatment. Primary endpoint was the accomplishment of a thrombocyte level superior to 130 × 109/L and the secondary endpoints were the return to chemotherapy and toxicity. Partial splenic embolization was done 36 times in 33 patients. All patients presented gastrointestinal cancer and colorectal malignancy was the commonest primary site. An average of 6.4 cycles of chemotherapy was done before splenic embolization and the most common regimen was Folfox. Mean platelet count prior to embolization was 69 × 109/L. A total of 94% of patients achieved primary endpoint. All patients in need reinitiated treatment and median time to chemotherapy return was 14 days. No grade 3 or above adverse events were identified. Aiming for a 50% to 70% infarction area may be sufficient to achieve success without the complications associated with more extensive infarction. Combined with the better safety profile, partial splenic embolization is an excellent option in the management of thrombocytopenia, enabling the resumption of systemic chemotherapy with minimal procedure-related morbidity.
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil. jhugoluz@gmail.com.
Jose Hugo M
JH
Luz
National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Paula M
PM
Luz
Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Edson
E
Marchiori
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Leonardo A
LA
Rodrigues
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Hugo R
HR
Gouveia
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Henrique S
HS
Martin
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Igor M
IM
Faria
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Roberto R
RR
Souza
Department of Clinical Oncology, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Roberto de Almeida
RA
Gil
Department of Clinical Oncology, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Alexandre de M
AM
Palladino
Department of Anesthesiology, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Karina B
KB
Pimenta
Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil.
Henrique S
HS
de Souza
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy*; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D013154:Spleen / Q000000981:diagnostic imaging; D013921:Thrombocytopenia / Q000139:chemically induced / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil
Cancer; interventional Radiology; oxaliplatin; partial splenic embolization; spleen; systemic chemotherapy; thrombocytopenia