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

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.