THE ROLE OF PALLIATIVE RADIOTHERAPY IN SYMPTOMATIC SPLENOMEGALY DEVELOPING AMONG ELDERLY PATIENTS WITH CHRONIC MYELOPROLIFERATIVE DISORDERS

Introduction: Chronic myeloproliferative diseases (CMD) are disorders of hematopoietic stem cells. CMD mostly occur in patients beyond the age of 60 years. Splenic irradiation has been used in CMD when other therapies were contraindicated or inefficient. Palliative splenic irradiation in CMD has often been used in selected cases where low-dose radiotherapy is effective in reducing the abdominal discomfort, clinical consequences of hipersplenism and also in improving the quality of life. Materials and Method: In this study, we have assessed the effect of splenic irradiation in 6 patients with CMD. All of them were no longer responsive to usual treatments, and they presented with at least one of the following: constitutional symptoms, abdominal discomfort, large splenic size or anemia. The period between the diagnosis and splenic irradiation was 41 (15-120) months. The radiotherapy schedule consisted of fractions of 0.5 Gy./day to be applied twice or three times a week. The mean total dose of radiotherapy per treatment was 7.5 Gy (5.5–10 Gy). Results: Abdominal discomfort was relieved in 100% of the patients. The mean reduction rate of the spleen was 64%. The median duration of the response was 8 (2-20) months. Slight cytopenia occurred in four patients. Conclusion: Splenic irradiation effectively palliates CMD-related symptoms, and constitutes an alternative therapy for patients who are refractory to usual treatments or for elderly patients with contrindications to surgery.