3:27 PM Abstract No. 402 Partial splenic artery embolization in 35 cancer patients

Abstract

Thrombocytopenia in cancer patients often contraindicates chemotherapy and/or surgery leading to suboptimal therapy and decreased overall survival. The purpose of our study was to determine safety and efficacy of partial splenic embolization to improve platelet count and to establish a standardized treatment plan to achieve ideal embolization endpoint and minimize postprocedural complications. Medical records of 35 cancer patients who underwent 39 splenic artery embolizations with 300-500 μm Embospheres were analyzed. The target embolization endpoint was 50-70% splenic infarct. Celiac plexus block was performed following 25 procedures for pain control. The spleen volumes were 1337 ± 1038 mL. The embolization led to 59 ± 16% splenic infarct. One mL of microspheres resulted in 272 ± 107 mL splenic infarct in patients with chemotherapy- or portal hypertension-induced splenomegaly and 582 ± 3 45 mL infarct in patients with hematologic malignancies. The spleen volumes decreased by 40.5 ± 11% in 1 year. The platelet count increased from 63.9 ± 29.6 (mean ± SD) to peak platelet count of 248 ± 118 in 2-4 weeks after embolization. Patients with follow-up period of >1 year had the last platelet count of 174 ± 113 (n = 12). The most common complication was moderate/severe pain which occurred in 92% of patients without celiac block and in 20% of patients with celiac block. There was non-occlusive portal vein thrombus in 2 patients, pulmonary embolus in 1 patient, focal pancreatitis in 1 patient, and increased ascites and pleural effusion in 7 patients. Procedure-related 30–day mortality was 25% amongst patients with hematologic malignancies and 0% amongst patients with chemotherapy- or portal hypertension-induced splenomegaly. Partial splenic embolization is effective to correct thrombocytopenia in cancer patients and provides improved platelet count for long-term. It is a low risk procedure in patients with chemotherapy- or portal hypertension-induced splenomegaly, but has high mortality in hematologic malignancies. The postprocedural pain was significantly reduced by celiac plexus block. Based on our data the required amount of beads can be calculated to achieve target splenic infarct.