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Radiation therapy for the spleen for malignant lymphoma

General

Indications

The spleen and lymph nodes along the splenic vessels and by the hilum of the spleen are considered one lymphatic region in the Ann Arbor system. Lymph node involvement in the spleen usually occurs as part of the general disease. With local treatment for lymphoma in the spleen, a splenectomy is an alternative that must be considered on an individual basis.    

Curative radiation therapy

  • Residual tumor in the speen after full chemotherapy for advanced Hodgkin's lymphoma (6-8 ABVD, 8 BEACOPP or equivalent) or aggressive lymphomas (6–8 CHOP-based cycles or equivalent) may be a circumstance for consolidative radiation therapy to the whole spleen. Alternatives may be a splenectomy, or with a negative biopsy, observation only. 
  • Special guidelines apply for children and adolescents up to 18 years with Hodgkin's lymphoma.
  • Localized stages of Hodgkin's lymphoma (stage IA/IIA) with spleen involvement, based on severity, are considered for consolidative radiation therapy to the involved field after 2–4 ABVD cycles or equivalent. Chemotherapy as for advanced disease may be considered an alternative, but radiation therapy is given only to residual lesions after a splenectomy. 
  • Localized stages of aggressive lymphomas (stage I/PeI-II1/PeII1), based on severity, are given consolidative radiation therapy after CHOP-based chemotherapy or equivalent to the initial tumor volume before chemotherapy. In both of these cases, the lymph nodes along the splenic vessels are included, and if necessary, the upper retroperitoneal lymph nodes as well to achieve adequate margins to the primary tumor area.  
  • Indolent lymphomas with localized spleen involvement almost never occur, and are primarily evaluated for splenectomy. 

Palliative radiation therapy

  • Palliative radiation therapy to the spleen for lymphoma or myeloproliferative disease is an alternative. The indications for this may be, for example, splenomegaly with abdominal discomfort or hypersplenism. Radiation therapy may also be an alternative for patients not expected to tolerate a splenectomy. 
  • It is important to evaluate the degree of extramedullary hematopoiesis in the spleen in these patients, since radiation therapy in many cases can lead to serious pancytopenia, especially if the spleen contributes signficantly to the hematopoiesis. 

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