Osman YOKUŞ, Esra CAN SARBACAK, Murat ALBAYRAK

Palliative splenic irradiation ın chronic myeloproliferative diseases

Kronik myeloproliferatif hastalıklarda (MPH), hastalığın ileri dönemlerinde massif splenomegali sıklıkla gözlen-mektedir. Bu hastalıklar sıklıkla 65 yaş üzerinde görülüp, dev splenomegali ve ilişkili semptomlar, özellikle primermyelofbrozda gözlenmektedir. Bu durumda pansitopeni, sol üst kadran ağrısı, anemi ve katabolik semptomlar geliş -mektedir. Bu nedenle tedavi ihtiyacı bu hastalıkta daha ön plandadır. Medikal tedavinin kontrendike olduğu yada et-kisiz olduğu ve aynı zamanda splenektomi yapılamayan yaşlı olgularda palyatif amaçlı splenik radyoterapi (SR) uy-gulanmaktadır. SR tekrarlanabilir bir tedavidir. Belli dozlarda, dikkatli klinik izlem ve destek tedavileriyle verilir -se yan etkisi az bir tedavidir. Janus kinase II (JAK-2) inhibitörü gibi bir çok yeni tedaviler henüz faz I-II aşamasındaolup, ancak önümüzdeki yıllarda klinikte kullanım alanı bulacak gibi gözükmektedir. Bu nedenle ileri yaşlarda ciddisemptomatik splenomegalisi olan hastalarda palyatif splenik radyoterapi, etkisi belli süreyle sınırlı olsa da, sempto -matik rahatlama sağlayıcı tedavi seçeneklerinin başında gelmektedir. Bu yazımızda; Kronik Myeloproliferatif Has -talıklarda splenik radyoterapinin palyatif amaçlı kullanıldığı durumlar, gelişebilecek komplikasyonlar ve hasta taki-bi gibi bu konuyla ilgili bilgiler ayrıntılı bir şekilde gözden geçirilecektir.

Kronik Myeloproliferatif hastalıklarda palyatif splenik radyoterapi

Massive splenomegaly is often observed in advanced stages of chronic myeloprolipherative disorders (MPD). MPDoften occur over age 65, and giant splenomegaly and related symptoms are observed particularly in primer myelof-brosis. In this case, pancytopenia, left upper quadrant discomfort, anemia and catabolic symptoms develop. There-fore, the need for treatment is of more importance. Palliative splenic irradiation (SR) is applied in the cases of old age,for which medical treatment is contraindicated or is ineffectual, and splenectomy cannot be performed. SR treatmentcan be repeated. In certain doses, this treatment has few side effects if applied with careful clinical observation andsupportive therapy. Several new treatments, such as Janus kinase II (JAK-2) inhibitor, are currently just in phase I-II,but they seem to be clinically used in the following years. Therefore, although the effect of palliative splenic irradia-tion is limited to a specifc term for elderly patients with severe symptomatic splenomegaly, it is one of the primarytreatment options which provides symptomatic relief. This article will review the information in detail on palliativesplenic irradiation applied in chronic myeloprolipherative disorders, complications of this treatment, and follow-upof these patients.

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