Partial splenic embolization to alleviate thrombocytopenia in stage III and IV pancreatic ductal adenocarcinoma patients

Benjamin O. Lawson, Rolf Hultsch, Lana Caldwell, Kevin P. Gosselin, Gayle Jameson, Erkut Borazanci


Background: Thrombocytopenia may be a concern in treating pancreatic ductal adenocarcinomas (PDAC). Due to anatomic position these tumors commonly cause narrowing or occlusion of the splenic vein which may lead to hypersplenism and thrombocytopenia due to sequestration. PDAC patients with thrombocytopenia have limited options for treatment. Partial splenic embolization (PSE) is a procedure developed as an alternative to splenectomy in individuals with hypersplenism. The purpose of our study was to review outcomes of PSE on thrombocytopenia in stage III and IV PDAC patients.
Methods: From November 2015 through January 2018, we conducted a retrospective chart analysis of 8 patients with stage III or stage IV pancreatic cancer who had undergone PSE. The primary objective of this retrospective study was to understand the utility of PSE in treating thrombocytopenia in pancreatic cancer patients by the effect on the individual’s platelet count and the subsequent exposure to chemotherapy treatment. Specific demographic data points were recorded including date of diagnosis, stage, location of primary origin, and site of metastasis. Other data including hospital days post-embolization, post-embolization syndrome (PES), days to return of chemotherapy, survival, and pre/post platelet counts at designated intervals were reviewed.
Results: Seven-eighths patients were diagnosed with stage IV pancreatic adenocarcinoma with the pancreatic head being the most common primary site (50%). Most common site of metastasis was liver. PES was found in 5/8 patients with the average number of hospital days after the procedure 1.38 (SD =1.06). Mean platelet count pre-splenic embolization was 93.00 (SD =12.59). One-week post-embolization mean platelet count was 147.00 (SD =69.60). Four-week (χ=183.60, SD =64.93), six-week (χ=148.40, SD =40.58), and three-month (χ=161.00, SD =79.07) intervals were used to further assess platelet change. The results of the ANOVA were significant, F(4) =3.65, P=0.027, =0.48. Post-hoc analyses revealed significant differences between one-week and four-week post-embolization (P=0.008). Time to restarting chemotherapy ranged from 1 to 129 days with an average day to restarting chemotherapy of 24.12 (SD =42.70). The median overall survival was 7.22 months.
Conclusions: In considering our study’s small sample size, PSE should be considered a safe approach in managing thrombocytopenia long-term in stage III or stage IV PDAC patients. PSE may allow for further chemotherapy to improve overall survival.