Abstract
There is renewed interest in the immune regulatory role of the spleen in oncology. To date, very few studies have examined macroscopic variations of splenic volume in the setting of cancer, prior to or during therapy, especially in humans. Changes in splenic volume may be associated with changes in splenic function. The purpose of this study was to investigate variations in spleen volume in NSCLC patients during chemo-radiotherapy. Sixty patients with stage I-IIIB NSCLC underwent radiotherapy (60Gy/30 fractions) for six weeks with concomitant carboplatin/paclitaxel (Ca/P; n = 32) or cisplatin/etoposide (Ci/E; n = 28). A baseline PET/CT scan was performed within 2 weeks prior to treatment and during Weeks 2 and 4 of chemo-radiotherapy. Spleen volume was measured by contouring all CT slices. Significant macroscopic changes in splenic volume occurred early after the commencement of treatment. A significant decrease in spleen volume was observed for 66% of Ca/P and 79% of Ci/E patients between baseline and Week 2. Spleen volume was decreased by 14.2% for Ca/P (p<0.001) and 19.3% for Ci/E (p<0.001) patients. By Week 4, spleen volume was still significantly decreased for Ca/P patients compared to baseline, while for Ci/E patients, spleen volume returned to above baseline levels. This is the first report demonstrating macroscopic changes in the spleen in NSCLC patients undergoing radical chemo-radiotherapy that can be visualized by non-invasive imaging.
Highlights
The spleen is involved as a predominant feature of many pathological conditions and there is renewed interest in its function in oncology [1]
We recently reported that positron emission tomography with computed tomography (PET/CT) imaging using the radiotracers 18F-30-deoxy-30-fluoro-l-thymidine (FLT) and 18F-fluoro-20-deoxy-d-glucose (FDG) can monitor and quantify organ-specific processes, including metabolic and proliferative activity in the spleen during and after chemo-radiotherapy in patients with non-small cell lung carcinoma (NSCLC) [8]
Chemo-radiotherapy is currently the mainstay of treatment for patients with potentially curable but unresectable locally advanced NSCLC, with a median overall survival of approximately 24 months reported in recent series [15,16,17]
Summary
The spleen is involved as a predominant feature of many pathological conditions and there is renewed interest in its function in oncology [1]. Assessment of splenic volume is important in the diagnosis, treatment and prognosis of diseases such as lymphoma, leukemia and other hematologic neoplasms [3,4]. Several conventional chemotherapeutics have already been shown to alter the splenic niche [5,6]. Low dose administration of several chemotherapeutic agents such as gemcitabine, fludarabine and 5-fluorouracil in tumor-bearing hosts can prevent the accumulation of myeloid derived suppressor cells (MDSCs) by restoring CD8+ T cells in the splenic niche [5]. In patients without gross tumor infiltration of the spleen, (which is uncommon in epithelial cancers) changes in splenic volume during treatment may be correlated with alterations in the number and function of immune effector cells in the spleen
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