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In Reply: I agree with Dr Schilling's assessment that one might expect a higher incidence of coronary artery disease in patients without prior splenectomy, related to additional incidental cardiac exposure with splenic irradiation. However, review of our data indicates that 10.7% of patients with a prior splenectomy developed coronary artery disease vs 10.0% of patients without splenectomy (P = .87). Similarly, carotid or subclavian artery disease developed in 7.5% of patients with splenectomy vs 7.4% without splenectomy (P>.99). We did find that clinically significant valve dysfunction developed in 8.8% of patients with prior splenectomy vs only 4.3% without splenectomy, but this difference was nonsignificant (P = .09).

In response to Drs Gyenes and Gyenes, the treatment techniques and radiation doses used in our study were relatively constant until the early 1990s when radiation doses, technique-related dose heterogeneity, and treatment volumes were reduced. Because of the long . . . [Full Text of this Article]

Nancy Price Mendenhall, MD
mendenan@shands.ufl.edu
Department of Radiation Oncology
University of Florida
Gainesville

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