Mose S, Pfitzner D, Rahn A, Nierhoff C, Schiemann M, Böttcher H D
Klinik für Strahlentherapie, Johann-Wolfgang-Goethe-Universität Frankfurt/Main.
Strahlenther Onkol. 2000 Nov;176(11):506-12. doi: 10.1007/pl00002317.
Chemotherapy is the treatment of choice in multiple myeloma; but there are no curative options. Therefore, the treatment rationale is characterized by reduction of symptoms and inhibition of complications. Regarding reduction of pain, treatment of (impending) fractures, and spinal cord compression radiation is an important part of palliative treatment. In our retrospective study we report the effect of radiotherapy on reduction of pain, recalcification and the reduction of neurological symptoms and evaluate factors which have an impact on therapeutic outcome.
From 1, Jan 1988 to 31, Dec 1998, 42 patients (19 women, 23 men; range of ages 46 to 85 years, median age 64.9 years) with 71 target volumes were irradiated (median dose 36 Gy, 2 to 3 Gy 5 times/week) because of symptomatic disease (67/71: osseous pain, 45/71: fractures/impending fractures, 13/71: spinal cord compression) (Tables 1 and 2). The median time from diagnosis to the first course of radiotherapy was 11.9 months (0.3 to 90 months). At the time of first irradiation, 5 and 37 patients were in tumor Stage II and III (Salmon/Durie), respectively. The median value of the Karnofsky performance was 70% (40 to 90%).
During follow-up (at least 6 months) in 85% of target volumes complete and partial pain relief (measured by patients' perception and the use of analgetic medication) was achieved; recurrences were seen in 8.8%. In 26/56 (46.4%) lesions evaluable a recalcification was seen whereas 17.9% showed progressive disease (comparison of radiographs before and after radiation). In 22.3% of all lesions initially with impending fracture (4/18) radiotherapy failed because of fracture after treatment (Tables 3 and 4). Simultaneous chemotherapy and a Karnofsky performance > or = 70 had a significant impact on a positive response to treatment, respectively. Spinal cord compression symptoms were reduced in 7/13 (53.8%) of patients (scaled due to the classification by Findlay 1987). The median survival from diagnosis for the entire group was 34.9 months (7.5 to 119.3 months), after irradiation 13.1 months (0.2 to 105.3 months) (Figure 1).
When adequately indicated radiotherapy has shown to be an effective palliative treatment. Taking under consideration that the results are retrospective we suppose that in multiple myeloma the local response to radiation is supported by a favorable performance status and simultaneous chemotherapy. Irradiation treatment does not change prognosis regarding overall survival.
化疗是多发性骨髓瘤的首选治疗方法；但尚无治愈方案。因此，治疗的基本原理是减轻症状和抑制并发症。关于减轻疼痛、治疗（即将发生的）骨折以及脊髓压迫，放射治疗是姑息治疗的重要组成部分。在我们的回顾性研究中，我们报告了放射治疗对减轻疼痛、重新钙化以及减轻神经症状的效果，并评估了对治疗结果有影响的因素。
1988年1月1日至1998年12月31日，42例患者（19例女性，23例男性；年龄范围46至85岁，中位年龄64.9岁），共71个靶区接受了放射治疗（中位剂量36 Gy，每周5次，每次2至3 Gy），原因是出现症状性疾病（67/71：骨痛，45/71：骨折/即将发生的骨折，13/71：脊髓压迫）（表1和表2）。从诊断到首次放射治疗疗程的中位时间为11.9个月（0.3至90个月）。首次放疗时，分别有5例和37例患者处于肿瘤Ⅱ期和Ⅲ期（Salmon/Durie分期）。卡氏功能状态评分的中位值为70%（40至90%）。
在随访期间（至少6个月），85%的靶区实现了完全或部分疼痛缓解（通过患者的感知和镇痛药的使用来衡量）；复发率为8.8%。在56个可评估的病变中，26个（46.4%）出现重新钙化，而17.9%显示疾病进展（放疗前后X线片对比）。在所有最初有即将发生骨折的病变中，22.3%（4/18）的放射治疗因治疗后骨折而失败（表3和表4）。同时进行化疗和卡氏功能状态评分≥70分别对治疗的阳性反应有显著影响。13例患者中有7例（53.8%）的脊髓压迫症状减轻（根据1987年Findlay的分类进行评分）。整个组从诊断开始的中位生存期为34.9个月（7.5至119.3个月），放疗后为13.1个月（0.2至105.3个月）（图1）。
在有充分指征时，放射治疗已被证明是一种有效的姑息治疗方法。考虑到结果是回顾性的，我们推测在多发性骨髓瘤中，良好的功能状态和同时进行化疗有助于局部对放疗的反应。放射治疗不会改变总体生存的预后。
