Prior splenic irradiation reduces hematologic adverse events during chemotherapy in pancreatic tail cancer: a report of a patient with liver cirrhosis

Thrombocytopenia is a major complication of liver cirrhosis that often limits the use of anticancer drugs. In this report, we describe a thrombocytopenic patient with liver cirrhosis who developed pancreatic tail cancer and underwent splenic irradiation. Particular emphasis was placed on the impact of irradiation on thrombocytopenia. A 73-year-old male with liver cirrhosis was diagnosed with pancreatic tail cancer infiltrating the splenic hilum by computed tomography (CT) and pancreatic juice cytology. His baseline platelet count was 84 × 10³/mm³. A total of 50 Gy of irradiation to the pancreatic tail and splenic hilum was carried out as local therapy for pancreatic cancer. Splenic irradiation was also expected to reverse liver cirrhosis-related thrombocytopenia, which was making systemic chemotherapy difficult to administer in this patient. One month later, systemic gemcitabine chemotherapy was commenced. At the start of chemotherapy, his platelet count remained at 93 × 10³/mm³, but rose to 246 × 10³/mm³ 2.5 months later, which allowed the administration of chemotherapy without any remarkable hematologic toxicities. Post-irradiation CT revealed a low density area indicating irradiation-induced necrotic tissue that had expanded into the surrounding non-tumorous spleen parenchyma, and which may have impacted positively on the thrombocytopenia. Our case report suggests that splenic irradiation may be a potential therapeutic option for liver cirrhosis-related thrombocytopenia, especially in patients who require systemic chemotherapy for cancer.