A prospective randomized phase II trial of splenic irradiation (SI) versus supportive therapy (ST) for patients (Pts) with hypersplenism (HS) secondary (2ry) to splenic periportal fibrosis (SPPF)

Abstract

16511 Background: HS 2ry to SPPF is a common problem in Egypt as a result of prevalence of bilharziasis. ST is the only option for the majority of pts who have poor performance status (PS) and cannot tolerate/refuse surgery. Methods: Aim of study was to evaluate the effect of SI versus ST on patients with HS 2ry to SPPF. Assessment of treatment was based on changes in Red Cell indices (RCI), Platelet indices (PI), splenic volume (SVol), and splenic vein diameter (SVD). In this study we had 19 evaluable Pts, 10 had SI and 9 had ST. Those who received SI had a twice weekly course of 1.5 Gy for a total of 3 weeks. RCI & PI were measured each visit, SVol & SVD (measured by duplex-Doppler US were measured initially, 3 & 6 months (mos) after treatment). Results: SVol & SVD increased significantly after 3 and 6 mos of ST, compared to insignificant decrease after 3 and 6 mos of SI. Platelet count (PC) significantly increased in all follow-ups (FU) after SI till 1.5 years compared to insignificant decreases in ST group after 3 and 6 mos. FU of mean platelet volume (MPV) and platelet distribution width (PDW) increased in ST group and decreased significantly in SI. Red blood cell (RBC) count and hemoglobin (Hb) levels increased significantly after SI till 6 and 9 mos respectively compared to insignificant decrease in RBC count and significant decrease in Hb level after 6 mos of ST. Changes in white blood cell counts were insignificant. After SI, changes in SVol showed significant positive correlations with changes in SVD and significant negative correlations with changes in PC. Changes in MPV showed significant positive correlation with changes in SVD. Side-effects (SE) seen with SI were moderate and transient. Conclusions: SI is a promising new modality of treatment with acceptable SE for pts with HS. Dose and schedule of SI should be modified according to pts PS. Changes in SVD are highly correlated with the degree of platelet and red cell turnover. Its predictive value for HS should be studied further. No significant financial relationships to disclose.