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SIR 2026

Traditional Poster

Interventional Oncology

Radioembolization

Session: Traditional Poster Presentations

572 - Splenic Radioembolization: A Novel Therapeutic Approach for Extreme Splenomegaly in Hematologic Malignancies

Monday, April 13, 2026
12:10 PM - 1:10 PM ET
Purpose: Patients with extreme splenomegaly frequently experience compressive symptoms and cytopenias, yet therapeutic options are limited. Splenectomy in this population carries a perioperative mortality rate as high as 20%. Partial splenic bland embolization can be performed but often requires multiple sessions to achieve meaningful volume reduction with acceptable morbidity. This study assessed the safety and efficacy of splenic radioembolization in patients with hematologic malignancies and extreme splenomegaly, defined as spleen volume at least five times greater than the predicted normal size for sex and height.

Materials and Methods: Between June 2023 and September 2025, 24 patients underwent splenic radioembolization with Y90–labeled resin microspheres. Of these, 20 patients (16 men, 4 women; mean age 64.2±9.2 years) with hematologic malignancies (18 myelofibrosis, 1 chronic lymphocytic leukemia, 1 hairy cell leukemia) and extreme splenomegaly formed the study cohort. Target dose was 70 Gy to the treatment volume, calculated with MIRD methodology. All patients had pre- and post-treatment dosimetry with SPECT-CT. Demographic, laboratory, and imaging data were prospectively recorded.

Results: Complete splenic radioembolization was achieved in 14 patients, and partial treatment (61–90% of volume) in 6 patients. Median follow-up was 8 months. Technical success was 100%. Delivered dose to the treated spleen was 67.7±12.4 Gy, measured on post-Y90 Bremsstrahlung SPECT-CT. Mean liver and lung shunts were 1.3±0.9% and 1.6±0.8%, respectively. The liver and lung doses were 2.7±1.2 Gy and 3.2±2.7 Gy. Baseline spleen volume was 2628±1717 mL (15.5±9.9x normal). Volume reductions at 1, 3, 6, 12, and 18 months were 35±22%, 56.1±17.1%, 65.9±13.4%, 73.6±7.8%, and 83.5±8.5%, respectively. No major complications occurred; minor events included fatigue and low-grade fever. Fifteen patients with myelofibrosis proceeded to successful allogenic stem cell transplantation after radioembolization.

Conclusion: Splenic radioembolization is a safe and effective therapy for extreme splenomegaly, achieving substantial volume reduction within months and avoiding the morbidity and mortality associated with splenectomy. This minimally invasive approach may represent a paradigm shift in the management of patients with extreme splenomegaly.