Partial splenic embolization in the treatment of prolonged thrombocytopenia due to hypersplenism in metastatic cancer patients

Abstract

Background: Hypersplenism-related thrombocytopenia (HST) may delay or preclude chemotherapy. Partial splenic embolization (PSE) has been used at our center to overcome prolonged HST.

Patients and methods: Between November 2012 and April 2015, 11 PSE procedures were performed in 10 patients; 9 had metastatic colorectal cancer and 1 had widespread pancreatic cancer. PSE was performed by selective catheterization of the splenic artery followed by injection of embolic particles, ranging from 300-700 um, until a 50% reduction in the splenic parenchyma blush was achieved.

Results: Splenomegaly was evaluated by splenic index, mean value 970 cm³ (range, 358-2277 cm³), normal mean 120-480 cm³. Mean platelet count immediately prior to PSE was 64.5 K/UL (range, 17-104 K/UL); within 10-14 days following the procedure, it increased to 224 K/UL (range, 83-669 K/UL). Only one patient's count remained less than 100 K/UL 2 weeks after embolization. After the procedure, all patients complained of mild abdominal pain that lasted for a few days; one patient developed post-embolization syndrome. No other significant complications were observed. Mean hospital stay was 2.5 days (range, 2-5 days). Chemotherapy was resumed 7-53 days (mean, 18 days) after the procedure in nine patients. One patient did not receive chemotherapy; he underwent local treatment of liver metastasis. Prolonged thrombocytopenia recurred in four patients, one of whom was successfully retreated by PSE.

Conclusions: PSE can be considered as a treatment option for HST.

Keywords: Colorectal cancer; Hypersplenism; Oncology; Partial splenic embolization; Thrombocytopenia.