The Role of Radiology and Radiotherapy for Multiple Myeloma

Abstract

Skeletal-related events occur in 80% of patients with multiple myeloma (MM). Osteoporosis, osteoclastic destructions, pathological fractures of the bone, spinal cord and compression can impair patients' quality of life and reduce survival. Many imaging techniques can be used for the detection of MM bone lesions. Many clinical studies suggest modern imaging techniques for their greater sensitivity. Radiotherapy is a treatment of choice for solitary plasmacytoma of the bone and extramedullary plasmacytomas. However, radiation treatment of MM can be used as a palliative approach for uncontrolled pain, impending pathological fractures and in the cases of spinal cord compression. Radiotherapy induces analgesic effect in 75-100% of patients and promotes a recalcification in 40-60%. In patients with spinal cord compression, radiation therapy is given along with dexamethasone, and up to half of patients may experience improvement. It is well known that pain perception, response to analgesics and pain relief effect of radiotherapy are quite different for multiple myeloma patients. Clinical, laboratory and genetic factors may influence the pain perception and analgesic effect of radiotherapy. Side effects of radiation are generally mild, are limited to the radiotherapy site and can be predicted.

Management of Pathological Thoracolumbar Vertebral Fractures in Patients With Multiple Myeloma: Multidisciplinary Recommendations

“…30 Radiotherapy also triggers the process of recalcification. 29 Dose restrictions for sensitive organs at risk must be considered. Combination with systemic treatment should be done very cautiously.…”

“…showed a significant reduction in 69% to 85% of cases and several radiotherapy regimens are available. [28][29][30] For a myeloma induced spinal cord compression Rades et al…”