Patient with polycythemia vera receiving radiation to spleen: a case report and review of the literature.

Abstract

Palliative treatment of splenomegaly from various malignant hematologic diseases using radiation has been accepted for a long time. Objective of splenic radiation is to relief clinical symptoms of splenomegaly and other clinical sequels of hypersplenism. Radiation to spleen gives good result with low toxicity. The most common side effects are thrombocytopenia and anemia which can not easily distinguish from underlying malignant hematologic diseases. This is a report case of a 55-year-old female with the diagnosis of polycythemia vera. The patient had huge splenomegaly with symptom of moderately severe abdominal distress. The patient was send to Radiation Therapy Department for splenic irradiation. Daily dose of 1.2 Gy for 5 fractions using right and left parallel oblique port was given to the patient causing minimal symptoms relieved. Thus, the daily dose was increased to 1.5 Gy for 5 more fractions. Second CT simulation was done after 13.5 Gy in 10 fractions. Anterior-posterior parallel opposed port with a daily dose of 2 Gy for 10 fractions was given to a shrinking spleen. The patient tolerated treatment very well and remained symptom-free at the end of treatment without any hematologic complication. Two and a half years follow-up showed no abdominal symptom nor hematologic sequelae. The literatures about splenic radiation are reviewed.