Single vs. multiple fraction regimens for palliative radiotherapy treatment of multiple myeloma

Abstract

PurposeTo 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 methodsIn 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.ResultsPain 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.ConclusionThe same analgesic and recalcification response was observed using two different radiotherapy regimens. Higher doses should be used to achieve a better QoL.

The Pain Relief and Recalcification Results of Radiotherapy for Plasma Cell Tumors

“…International Journal of Hematology and Oncology emphasized that recalcification rates were affected significantly by performance status, haemoglobin level and stage of disease. 14 Our recalcification response rate was 96.3% for all patients. However, complete response was identified only 51.3% of patients.…”

“…But the results of those randomized trials do not show superiority of any particular RT regimen. 14 The role of different RT dose levels for PCNs is not established clearly.…”

Radiation Therapy for Solitary Plasmacytoma and Multiple Myeloma: Guidelines From the International Lymphoma Radiation Oncology Group

“…Definitive radiation therapy with a total dose of 50 Gy in 25 fractions comparison with volumetric arc therapy (VMAT) (G) and 3D conformal (H) techniques, and VMAT was chosen as it gave a superior conformal coverage of the planning target volume, and substantial reduction in doses to the heart and lungs (mean heart dose of 5.7 Gy vs 19.9 Gy; and mean lung dose of 3.7 Gy vs 10.8 Gy), as illustrated in the dose volume histogram (DVH) (I). scales was only seen with the fractionated regimen (56). Another prospective randomized trial (57) compared a shorter (20 Gy in 5 fractions) and a longer course (30 Gy in 10 fractions) regimen in patients affected with metastatic epidural spinal cord compression from different tumor types and showed no differences both in terms of 6-month functional outcomes (57.5% vs 60%, respectively) and local control (75.2% vs 81.8%, respectively) between the 2 arms.…”

The Role of Radiology and Radiotherapy for Multiple Myeloma

“…Hundred and one patients were involved in a randomised prospective clinical study performed at the Lithuanian University of Health Sciences [44]. Two different radiation treatment regimens of bone destructions due to multiple myeloma were compared.…”

“…The study performed by Rudzianskiene et al involved analysis of 12 gene polymorphisms of six cytokines (IL-6, IL-10, TNFα, IL-1α, IL-1β and IL-1RA) participating in the pathogenesis of the pain syndrome in bone destruction sites. The aim was to evaluate the influence of interleukins on the perception of pain and response to radiotherapy in MM patients [44].…”