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Seventeen patients with either chronic myelogenous leukemia (CML) or myelofibrosis with myeloid metaplasia (MMM) received 24 courses of splenic irradiation at this institution from 1973 to 1982. Eleven of the 17 patients had received prior chemotherapy. Patients were treated with 60Co gamma rays or 6 MV photons. The fraction size ranged from 15 to 100 rad and the total dose per treatment course from 15 to 650 rad, with the exception of one patient who received 1650 rad. Fourteen of 19 courses (71%) given for splenic pain yielded significant subjective relief while 17 of 26 courses given for splenomegaly obtained at least 50% regression of splenic size. Blood counts were carefully monitored before each treatment to limit hematologic toxicity. From this experience, the authors conclude that splenic irradiation effectively palliates splenic pain and reverses splenomegaly in the majority of patients with CML and MMM. Intermittent fractionation (twice or thrice weekly) is more convenient for the patient, appears to be as effective as daily treatment, and may be associated with less hematologic toxicity. Preliminary results of concurrent treatment with splenic irradiation and oral hydroxyurea show promise and warrant further study.

A family of computer programs has been developed to help physicians effectively utilize available clinical information as in indicator of tumor extent for the staging of Hodgkin's disease patients. Decision analysis techniques were employed to suggest chronologic sequencing of selected, risk-associated tests, tailored to the individual patient, that minimize the risk of iatrogenic mortality. These quantitative techniques provide an objective measure of expected survival for a given plan of action. By using this information a physician and patient can balance expected survival vs morbidity of proposed staging procedures. Physicians can then focus on the interrelation between the inherent diagnostic uncertainty, therapy-induced expected survival, and morbid consequences of staging procedures. The use of these decision-making tools enables the physician to identify patient-specific presentations where the formation of an individual diagnostic plan could lead both to reduction in testing and to an increased survival rate.