Palliative splenic irradiation in primary and post PV/ET myelofibrosis: outcomes and toxicity of three radiation schedules

Mario Federico, Guido Pagnucco, Antonio Russo, Giovanni Cardinale, Patrizia Guerrieri, Francesco Sciumè, Catherine Evangeline Symonds, Letizia Cito, Sergio Siragusa, Nicola Gebbia, Roberto Lagalla, Massimo Midiri, Antonio Giordano, Paolo Montemaggi
  • Guido Pagnucco
    U.O. Ematologia – ARNAS Civico -Dipartimento Oncologico M. Ascoli. Palermo, Italy
  • Antonio Russo
    U.O. Oncologia Medica - Università degli Studi di Palermo, Italy
  • Giovanni Cardinale
    U.O. Ematologia – ARNAS Civico -Dipartimento Oncologico M. Ascoli. Palermo, Italy
  • Patrizia Guerrieri
    U.O. Radioterapia – ARNAS Civico - Dipartimento Oncologico M. Ascoli – Palermo, Italy
  • Francesco Sciumè
    U.O. Radioterapia – ARNAS Civico - Dipartimento Oncologico M. Ascoli – Palermo, Italy
  • Catherine Evangeline Symonds
    SHRO, United States
  • Letizia Cito
    CROM, Centro Ricerche Oncologiche – Mercogliano, Italy, Italy
  • Sergio Siragusa
    Hematology department , University of Palermo, Italy
  • Nicola Gebbia
    Medical Oncology dept. University of Palermo, Italy
  • Roberto Lagalla
    DiBiMeL University of Palermo, Italy
  • Massimo Midiri
    DiBiMeL University of Palermo, Italy
  • Antonio Giordano
    SHRO - Temple University, United States
  • Paolo Montemaggi
    U.O. Radioterapia – ARNAS Civico - Dipartimento Oncologico M. Ascoli – Palermo, Italy


Splenectomy and splenic irradiation (SI) are the sole treatment modalities to control drug resistant splenomegaly in patients with myelofibrosis (MF). SI has been used in poor surgical candidates but optimal total dose and fractionation are unclear. We retrospectively reviewed 14 MF patients with symptomatic splenomegaly. Patients received a median of 10 fractions in two weeks. Fraction size ranged from 0.2-1.4 Gy, and total dose varied from 2-10.8 Gy per RT course. Overall results indicate that 81.8% of radiation courses achieved a significant spleen reduction. Splenic pain relief and gastrointestinal symptoms reduction were obtained in 94% and 91% of courses, respectively. Severe cytopenias occurred in 13% of radiation courses. Furthermore patients were divided in three groups according to the radiation dose they received: 6 patients in the low-dose group (LDG) received a normalized dose of 1.67 Gy; 4 patients in the intermediate-dose group (IDG) received a normalized dose 4.37 Gy; the remaining 4 patients in the high-dose group (HDG) received a normalized dose of 9.2 Gy. Subgroup analysis showed that if no differences in terms of treatment’s efficacy were seen among dose groups, hematologic toxicity rates distributed differently. Severe cytopenias occurred in 50% of courses in the HDG, and in the 14.3% and in 0% of the IDG and LDG respectively. Spleen reduction and pain relief lasted for a median of 5.5 months in all groups. Due to the efficacy and tolerability of the low-dose irradiation 4 patients from the LDG and IDG were retreated and received on the whole 12 RT courses. Multiple retreatments did not show decremental trends in terms of rates of response to radiation nor in terms of duration of clinical response. Moreover, retreatment courses did not cause an increased rate of adverse effects and none of the retreated patients experienced severe hematologic toxicities. The average time of clinical benefit in retreated patients was much longer (21 months, range 44-10) than patients who were not retreated (5,75 months, range 3-6).


Myelofibrosis; splenomegaly; palliation; radiotherapy; low dose irradiation

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Submitted: 2009-01-16 01:22:41
Published: 2009-05-04 10:57:42
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