Partial splenic embolization to permit continuation of systemic chemotherapy

Jose Hugo M Luz; Paula M Luz; Edson Marchiori; Leonardo A Rodrigues; Hugo R Gouveia; Henrique S Martin; Igor M Faria; Roberto R Souza; Roberto de Almeida Gil; Alexandre de M Palladino; Karina B Pimenta; Henrique S de Souza

doi:10.1002/cam4.856

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Partial splenic embolization to permit continuation of systemic chemotherapy

Journal article

Peer reviewed

Partial splenic embolization to permit continuation of systemic chemotherapy

Jose Hugo M Luz, Paula M Luz, Edson Marchiori, Leonardo A Rodrigues, Hugo R Gouveia, Henrique S Martin, Igor M Faria, Roberto R Souza, Roberto de Almeida Gil, Alexandre de M Palladino, …

Cancer medicine (Malden, MA), Vol.5(10), pp.2715-2720

10/2016

DOI: 10.1002/cam4.856

PMID: 27611010

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Abstract

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 × 10 /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 × 10 /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.

Adult

Aged

Aged, 80 and over

Antineoplastic Combined Chemotherapy Protocols - administration & dosage

Antineoplastic Combined Chemotherapy Protocols - adverse effects

Drug Administration Schedule

Embolization, Therapeutic - methods

Female

Fluorouracil - administration & dosage

Fluorouracil - adverse effects

Gastrointestinal Neoplasms - drug therapy

Humans

Leucovorin - administration & dosage

Leucovorin - adverse effects

Male

Middle Aged

Organoplatinum Compounds - administration & dosage

Organoplatinum Compounds - adverse effects

Prospective Studies

Spleen - diagnostic imaging

Thrombocytopenia - chemically induced

Thrombocytopenia - therapy

Tomography, X-Ray Computed

Treatment Outcome

Details

Title: Subtitle: Partial splenic embolization to permit continuation of systemic chemotherapy
Creators: Jose Hugo M Luz - Hospital do Câncer III
Paula M Luz - Instituto Evandro Chagas
Edson Marchiori - Universidade Federal do Rio de Janeiro
Leonardo A Rodrigues - Hospital do Câncer III
Hugo R Gouveia - Hospital do Câncer III
Henrique S Martin - Hospital do Câncer III
Igor M Faria - Hospital do Câncer III
Roberto R Souza - Department of Interventional Radiology, Radiology Division, National Cancer Institute, INCA, Rio de Janeiro, Brazil
Roberto de Almeida Gil - Department of Clinical Oncology, National Cancer Institute, INCA, Rio de Janeiro, Brazil
Alexandre de M Palladino - Department of Clinical Oncology, National Cancer Institute, INCA, Rio de Janeiro, Brazil
Karina B Pimenta - Hospital do Câncer III
Henrique S de Souza - Hospital do Câncer III
Resource Type: Journal article
Publication Details: Cancer medicine (Malden, MA), Vol.5(10), pp.2715-2720
DOI: 10.1002/cam4.856
PMID: 27611010
ISSN: 2045-7634
eISSN: 2045-7634
Grant note: UM1 AI069476 / NIAID NIH HHS
Language: English
Date published: 10/2016
Academic Unit: Radiology
Record Identifier: 9985177933602771

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