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Oertel M, Schlusemann T, Shumilov E, Reinartz G, Bremer A, Rehn S, Lenz G, Khandanpour C, Eich HT. Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma-A Critical Toxicity Evaluation in the Modern Treatment Era. Cancers (Basel) 2023; 15:cancers15112909. [PMID: 37296874 DOI: 10.3390/cancers15112909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Radiotherapy (RT) is an established treatment modality in the management of patients with multiple myeloma (MM), aiming at analgesia and stabilization of osteolytic lesions. As a multifocal disease, the combined use of RT, systemic chemotherapy, and targeted therapy (ST) is pivotal to achieve better disease control. However, adding RT to ST may lead to increased toxicity. The aim of this study was to evaluate the tolerability of ST given concurrently with RT. Overall, 82 patients treated at our hematological center with a median follow-up of 60 months from initial diagnosis and 46.5 months from the start of RT were evaluated retrospectively. Toxicities were recorded from 30 days before RT up to 90 days after RT. 54 patients (65.9%) developed at least one non-hematological toxicity, with 50 patients (61.0%) showing low-grade (grade I or II) and 14 patients (17.1%) revealing high-grade (grade III and IV) toxicities. Hematological toxicities were documented in 50 patients (61.0%) before RT, 60 patients (73.2%) during RT, and 67 patients (81.7%) following RT. After RT, patients who had received ST during RT showed a significant increase in high-grade hematological toxicities (p = 0.018). In summary, RT can be safely implemented into modern treatment regimens for MM, but stringent monitoring of potential toxicities even after completion of RT has to be ensured.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Tom Schlusemann
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Evgenii Shumilov
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Gabriele Reinartz
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Anne Bremer
- Department of Oncology, St. Franziskus-Hospital, Hohenzollernring 70, 48145 Muenster, Germany
| | - Stephan Rehn
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Cyrus Khandanpour
- Department of Hematology and Oncology, University Hospital of Schleswig-Holstein, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Pielkenrood BJ, Visser TF, van Tol FR, Foppen W, Eppinga WSC, Verhoeff JJC, Bol GH, Van der Velden JM, Verlaan JJ. Remineralization of lytic spinal metastases after radiotherapy. Spine J 2023; 23:571-578. [PMID: 36623735 DOI: 10.1016/j.spinee.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/07/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND CONTEXT Palliative radiotherapy (RT) can lead to remineralization of osteolytic lesions thereby potentially restoring some of the weight-bearing capacity and preventing vertebral collapse. It is not clear, however, under which circumstances remineralization of osteolytic lesions occurs. PURPOSE The aim of this study was to investigate the change in bone mineral density in spinal metastases after RT compared to a reference region, and find associated factors. STUDY DESIGN Retrospective analysis within prospective observational cohort OUTCOME MEASURES: change in bone mineral density measured in Hounsfield Units (HU). PATIENT SAMPLE patients treated with RT for (painful) bone metastases. METHODS Patients with spinal metastases were included if computed tomography scans both pre- and post-RT were available. Bone density was measured in HU. A region of interest (ROI) was drawn manually in the metastatic lesion. As a reference, a measurement of bone density in adjacent, unaffected, and non-irradiated vertebrae was used. Factors tested for association were origin of the primary tumor, RT dose and fractionation scheme, and concomitant use of bisphosphonates. RESULTS A total of 31 patients with 49 spinal metastases, originating from various primary tumors, were included. The median age on baseline was 58 years (IQR: 53-63) and median time between baseline and follow-up scan was 8.2 months (IQR: 3.0-18.4). Difference in HU in the lesion before and after treatment was 146.9 HU (95% CI 68.4-225.4; p<.01). Difference in HU in the reference vertebra between baseline and first follow-up was 19.1 HU (95% CI -47.9 to 86.0; p=.58). Difference between reference vertebrae and metastatic lesions on baseline was -194.1 HU (95% CI -276.2 to -112.0; p<.01). After RT, this difference was reduced to -50.3 HU (95% CI -199.6 to 99.0; p=.52). Patients using bisphosphonates showed a greater increase in HU, 194.1 HU versus 60.6 HU, p=.01. CONCLUSIONS Palliative radiation of osteolytic lytic spinal metastases is positively associated with an increased bone mineral density at follow-up. The use of bisphosphonates was linked to an increased bone mineral density when used during or after RT.
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Affiliation(s)
- Bart J Pielkenrood
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Thomas F Visser
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Floris R van Tol
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wietse S C Eppinga
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Gijs H Bol
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Joanne M Van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Guerini AE, Tucci A, Alongi F, Mataj E, Belotti A, Borghetti P, Triggiani L, Pegurri L, Pedretti S, Bonù M, Tomasini D, Imbrescia J, Donofrio A, Facheris G, Singh N, Volpi G, Tomasi C, Magrini SM, Spiazzi L, Buglione M. RR Myelo POINT: A Retrospective Single-Center Study Assessing the Role of Radiotherapy in the Management of Multiple Myeloma and Possible Interactions with Concurrent Systemic Treatment. Cancers (Basel) 2022; 14:cancers14092273. [PMID: 35565401 PMCID: PMC9099690 DOI: 10.3390/cancers14092273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background and purpose: Although chemotherapy, biological agents, and radiotherapy (RT) are cornerstones of the treatment of multiple myeloma (MM), the literature regarding the possible interactions of concurrent systemic treatment (CST) and RT is limited, and the optimal RT dose is still unclear. Materials and methods: We retrospectively analyzed the records of patients who underwent RT for MM at our institution from 1 January 2005 to 30 June 2020. The data of 312 patients and 577 lesions (treated in 411 accesses) were retrieved. Results: Most of the treated lesions involved the vertebrae (60%) or extremities (18.9%). Radiotherapy was completed in 96.6% of the accesses and, although biologically effective doses assuming an α/β ratio of 10 (BED 10) > 38 Gy and CST were significantly associated with higher rates of toxicity, the safety profile was excellent, with side effects grade ≥2 reported only for 4.1% of the accesses; CST and BED 10 had no impact on the toxicity at one and three months. Radiotherapy resulted in significant improvements in performance status and in a pain control rate of 87.4% at the end of treatment, which further increased to 96.9% at three months and remained at 94% at six months. The radiological response rate at six months (data available for 181 lesions) was 79%, with only 4.4% of lesions in progression. Progression was significantly more frequent in the lesions treated without CST or BED 10 < 15 Gy, while concurrent biological therapy resulted in significantly lower rates of progression. Conclusion: Radiotherapy resulted in optimal pain control rates and fair toxicity, regardless of BED 10 and CST; the treatments with higher BED 10 and CST (remarkably biological agents) improved the already excellent radiological disease control.
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Affiliation(s)
- Andrea Emanuele Guerini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Alessandra Tucci
- Department of Haematology, ASST-Spedali Civili Hospital, 25123 Brescia, Italy; (A.T.); (A.B.)
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar Di Valpolicella, Italy;
| | - Eneida Mataj
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Angelo Belotti
- Department of Haematology, ASST-Spedali Civili Hospital, 25123 Brescia, Italy; (A.T.); (A.B.)
| | - Paolo Borghetti
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
- Correspondence: ; Tel.: +39-0303995272
| | - Luca Triggiani
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Ludovica Pegurri
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Sara Pedretti
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Marco Bonù
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Davide Tomasini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Jessica Imbrescia
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Alessandra Donofrio
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Giorgio Facheris
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Navdeep Singh
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Giulia Volpi
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Cesare Tomasi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Section of Public Health and Human Sciences, University of Brescia, 25123 Brescia, Italy;
| | - Stefano Maria Magrini
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
| | - Luigi Spiazzi
- Medical Physics Department, ASST Spedali Civili Hospital, 25123 Brescia, Italy;
| | - Michela Buglione
- Department of Radiation Oncology, University of Brescia and Spedali Civili Hospital, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (A.E.G.); (E.M.); (L.T.); (L.P.); (S.P.); (M.B.); (D.T.); (J.I.); (A.D.); (G.F.); (N.S.); (G.V.); (S.M.M.); (M.B.)
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König L, Herfarth K. [Benefits of radiotherapy for patients with solitary plasmacytoma or multiple myeloma]. Radiologe 2021; 62:30-34. [PMID: 34762165 DOI: 10.1007/s00117-021-00935-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Treatment options for patients with solitary plasmacytoma (SP) or multiple myeloma (MM) should be discussed in an interdisciplinary context. This systematic review focuses on the importance of radiotherapy in MM and SP. OBJECTIVE Summary of local radio-oncological treatment options for patients with SP and MM. MATERIALS AND METHODS Based on a systematic literature search, the current evidence on the topic was analyzed and summarized. RESULTS Patients with SP should be primarily treated with radiotherapy with or without surgery. Irradiation concepts may vary depending on risk factors and manifestation (solitary bone plasmacytoma vs. solitary extramedullary plasmacytoma). Although local control rates are high after radiotherapy, progression to multiple myeloma frequently occurs. In patients with MM, radiation is mainly used in palliative settings for pain relief, prevention of fractures or in patients who suffer from neurological symptoms due to spinal cord compression. Irradiation dose and fractionation should be selected based on treatment indication and general condition of the patient. CONCLUSION Although most patients receive systemic treatment at initial diagnosis, approximately 40% of patients with MM will require radiation during the course of their disease. While radiation is mainly used for palliation in patients with MM, it represents the primary and curative treatment option in patients with SP.
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Affiliation(s)
- Laila König
- Abteilung RadioOnkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - Klaus Herfarth
- Abteilung RadioOnkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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Reis T, Schneider F, Welzel G, Schmidt R, Bludau F, Obertacke U, Wenz F. Intraoperative Radiotherapy during Kyphoplasty for Vertebral Metastases (Kypho-IORT): First Clinical Results. TUMORI JOURNAL 2018; 98:434-40. [DOI: 10.1177/030089161209800406] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Kyphoplasty is an effective procedure providing structural stability and pain alleviation in vertebral metastases. To prevent early regrowth, patients typically receive postoperative fractionated radiotherapy, which is associated with long treatment duration. Therefore, we established a new approach to deliver intraoperative radiotherapy during kyphoplasty to shorten the treatment time and reach structural stability and sterilization of the metastases (Kypho-IORT). Methods and study design For Kypho-IORT, a 50 kV X-ray source with a specially designed applicator was used. A radiation dose of 8 Gy in 5 mm distance was delivered. After radiation the device was removed and the kyphoplasty was completed according to the standard procedure. Since August 2009, 18 patients with instable or painful spinal metastases received Kypho-IORT. The median age was 63 years (range, 43–73). Results Kypho-IORT was successfully performed in 18 of 21 vertebral lesions (86%). No severe complications occurred during or early after IORT. The median pain score using a visual analogue scale decreased from 5/10 before the procedure to 2.5/10 at day 1 (P <0.001) and to 0/10 six weeks after the procedure (P = 0.001). Imaging studies were available for 15 of 18 patients. Stable disease within the irradiated vertebral body was seen in 14 patients (93%) and local progressive disease in one patient (7%). No re-irradiation due to local progressive disease or pain recurrence was necessary within the median follow-up of 4.5 months. Conclusions Kypho-IORT is well tolerated without severe side effects and provides fast improvement of pain. Although stable disease was seen in 93% of the patients, a longer follow-up is necessary to assess the effectiveness. A dose escalation study to establish the maximally tolerated dose has been initiated.
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Affiliation(s)
| | | | | | - Renè Schmidt
- Department for Orthopedics and Trauma Surgery, University Medical Centre Mannheim, University of Heidelberg, Germany
| | - Frederic Bludau
- Department for Orthopedics and Trauma Surgery, University Medical Centre Mannheim, University of Heidelberg, Germany
| | - Udo Obertacke
- Department for Orthopedics and Trauma Surgery, University Medical Centre Mannheim, University of Heidelberg, Germany
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Lang K, König L, Bruckner T, Förster R, Sprave T, Schlampp I, Bostel T, Welte S, Nicolay NH, Debus J, Rief H. Stability of Spinal Bone Lesions in Patients With Multiple Myeloma After Radiotherapy-A Retrospective Analysis of 130 Cases. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 17:e99-e107. [PMID: 28993162 DOI: 10.1016/j.clml.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/13/2017] [Accepted: 09/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of the present retrospective analysis was the response evaluation regarding bone density and stability of patients with osteolytic spinal bone lesions due to multiple myeloma after palliative radiotherapy (RT). PATIENTS AND METHODS Patients with multiple myeloma who had undergone spinal RT from March 2003 to May 2016 were analyzed before and 3 and 6 months after RT. Assessment of spinal stability and bone density was performed using the internationally recognized Taneichi scoring system and measurement of bone density using computed tomography imaging-based Hounsfield units. For statistical analysis, we used the Bowker test, McNemar test, and κ statistics to detect possible asymmetries in the distribution of the Taneichi score over time. We used the Student t test for comparison of the density values (Hounsfield units) before and after treatment. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. Additionally, overall survival was calculated using the Kaplan-Meier method. RESULTS We evaluated 130 patients (69% male; 31% female) with multiple myeloma and a median age of 58 years. The median follow-up period was 41 months. Before treatment, 51% of the lesions were classified as unstable. At 3 and 6 months after RT, this rate had decreased to 41% (P = .0047) and 24% (P = .2393), respectively. The computed tomography measurements showed a significant increase in bone density at 3 and 6 months after RT. Acute RT-related grade 1 and 2 complications were detected in 34% of patients. Late side effects (grade 1-2) were detected in 23% of the patients. No severe grade 3 or 4 acute or late toxicities were identified. The median overall survival was 19.7 months for all patients and 6.6 months for patients with a Karnofsky performance score of ≤ 70%. CONCLUSION To the best of our knowledge, ours is the first report to analyze the bone density and stability in patients with multiple myeloma after RT using a validated scoring system and computed tomography imaging. Palliative RT is an effective method resulting in a significant increase in bone density for local response and stability without severe RT-related toxicity. Furthermore, recalcification could already be detected at 3 months after treatment.
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Affiliation(s)
- Kristin Lang
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Thomas Bruckner
- Department of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Robert Förster
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Ingmar Schlampp
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Tilman Bostel
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Stefan Welte
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Harald Rief
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.
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Single vs. multiple fraction regimens for palliative radiotherapy treatment of multiple myeloma : A prospective randomised study. Strahlenther Onkol 2017; 193:742-749. [PMID: 28573476 PMCID: PMC5570777 DOI: 10.1007/s00066-017-1154-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/11/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the impact of a single fraction (8 Gy × 1 fraction) and multifraction (3 Gy × 10 fractions) radiotherapy regimens on pain relief, recalcification and the quality of life (QoL) in patients with bone destructions due to multiple myeloma (MM). PATIENTS AND METHODS In all, 101 patients were included in a randomised prospective clinical trial: 58 patients were included in the control arm (3 Gy × 10 fractions) and 43 patients into the experimental arm (8 Gy × 1 fraction). The response rate was defined according to the International Consensus on Palliative Radiotherapy criteria. Recalcification was evaluated with radiographs. QoL questionnaires were completed before and 4 weeks after treatment. RESULTS Pain relief was obtained in 81/101 patients (80.2%): complete response in 56 (69%) and partial in 25 patients (30.9%). No significant differences were observed in analgesic response between the groups. Significant factors for pain relief were female gender, age under 65, IgG MM type, presence of recalcification at the irradiated site. Recalcification was found in 32/101 patients (33.7%): complete in 17 (53.2%) and partial in 15 (46.2%). No significant differences were observed in recalcification between the groups. Significant factors for recalcification were Karnofsky index ≥ 60%, haemoglobin level ≤ 80 g/dl, MM stage II and analgesic response at the irradiated site. The QoL after radiotherapy was improved in the control group. CONCLUSION The same analgesic and recalcification response was observed using two different radiotherapy regimens. Higher doses should be used to achieve a better QoL.
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Matuschek C, Ochtrop TA, Bölke E, Ganswindt U, Fenk R, Gripp S, Kröpil P, Gerber PA, Kammers K, Hamilton J, Orth K, Budach W. Effects of Radiotherapy in the treatment of multiple myeloma: a retrospective analysis of a Single Institution. Radiat Oncol 2015; 10:71. [PMID: 25889851 PMCID: PMC4391087 DOI: 10.1186/s13014-015-0374-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/06/2015] [Indexed: 11/24/2022] Open
Abstract
Background Palliative irradiation of osteolytic lesions is a considerable component in the treatment for patients with multiple myeloma. In this study, we analyzed the efficacy of irradiation in these patients. Patients and methods We retrospectively analyzed 153 patients with multiple myeloma who were admitted to our department between 1989 and 2013. According to the staging system of Durie & Salmon 116 patients were classified as stage III. 107/153 patients were treated with radiotherapy of at least one and up to 6 bony lesions at different times. In order to evaluate the effect of local radiotherapy on pain relief and bone recalcification a uni- and multivariate analysis was performed using a binary logistic regression model to correct for multiple measurements. Complete information on dose, fractionation and volume of radiotherapy was available from 81 patients treated in 136 target volumes for pain relief, and from 69 patients treated in 108 target volumes for recalcification. Total radiation doses varied between 8 Gy to 50 Gy (median dose 25 Gy in 2.5 Gy fractions, 5 times a week). Results Radiotherapy resulted in complete local pain relief in 31% and partial local pain relief in 54% of the patients. In the univariate analysis, higher total radiation doses (p = 0.023) and higher age (p = 0.014) at the time of radiotherapy were significantly associated with a higher likelihood of pain relief, whereas no significant association was detected for concurrent systemic treatment, type and stage of myeloma and location of bone lesions. The same variables were independent predictors for pain relief in the multivariate analysis. Recalcification was observed in 48% of irradiated bone lesions. In the uni- and multivariate analysis higher radiation doses were significantly associated (p = 0.048) with an increased likelihood of recalcification. Side effects of radiotherapy were generally mild. Conclusions Higher total biological radiation doses were associated with better pain relief and recalcification in this retrospective evaluation of multiple myeloma patients. In addition, in the elderly the therapeutic measures appear to develop a better analgesic effect.
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Affiliation(s)
- Christiane Matuschek
- Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Thomas A Ochtrop
- Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Edwin Bölke
- Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Ute Ganswindt
- Department of Radiation Oncology, Faculty of Medicine, University of Munich (LMU), Munich, Germany.
| | - Roland Fenk
- Department of Hematology Oncology and Clinical Immunology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany.
| | - Stephan Gripp
- Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Patric Kröpil
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany.
| | - Peter Arne Gerber
- Department of Dermatology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany.
| | - Kai Kammers
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jackson Hamilton
- Faculty of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Klaus Orth
- Department of General, Medical Faculty, Visceral, and Thoracic Surgery, Asklepios Harz Hospitals, Goslar, Germany.
| | - Wilfried Budach
- Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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Rolle der Strahlentherapie bei strahlensensiblen und strahlenresistenteren Knochentumoren. DER ONKOLOGE 2013. [DOI: 10.1007/s00761-013-2513-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schneider F, Greineck F, Clausen S, Mai S, Obertacke U, Reis T, Wenz F. Development of a Novel Method for Intraoperative Radiotherapy During Kyphoplasty for Spinal Metastases (Kypho-IORT). Int J Radiat Oncol Biol Phys 2011; 81:1114-9. [PMID: 20934272 DOI: 10.1016/j.ijrobp.2010.07.1985] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 07/05/2010] [Accepted: 07/09/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Frank Schneider
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany.
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Impact of Radiotherapy on Pain Relief and Recalcification in Plasma Cell Neoplasms. Strahlenther Onkol 2011; 187:114-9. [DOI: 10.1007/s00066-010-2155-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
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Momm F, Lingg S, Xander C, Adebahr S, Grosu AL, Becker G. Die Situation der Angehörigen von Strahlentherapiepatienten. Strahlenther Onkol 2010; 186:344-50. [DOI: 10.1007/s00066-010-2111-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
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Corradini S, Belka C, Plasswilm L. Strahlentherapie bei solitärem Plasmozytom oder multiplem Myelom. ONKOLOGE 2010. [DOI: 10.1007/s00761-010-1787-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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