Lang Kristin, König Laila, Bruckner Thomas, Förster Robert, Sprave Tanja, Schlampp Ingmar, Bostel Tilman, Welte Stefan, Nicolay Nils H, Debus Jürgen, Rief Harald
Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.
Department of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany.
Clin Lymphoma Myeloma Leuk. 2017 Dec;17(12):e99-e107. doi: 10.1016/j.clml.2017.09.005. Epub 2017 Sep 19.
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 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.
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%.
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.
本回顾性分析的目的是评估多发性骨髓瘤所致溶骨性脊柱骨病变患者在姑息性放疗（RT）后骨密度和稳定性的反应情况。
对2003年3月至2016年5月期间接受脊柱放疗的多发性骨髓瘤患者在放疗前、放疗后3个月和6个月进行分析。使用国际认可的谷内评分系统评估脊柱稳定性和骨密度，并使用基于计算机断层扫描成像的亨氏单位测量骨密度。为进行统计分析，我们使用Bowker检验、McNemar检验和κ统计量来检测谷内评分随时间分布的可能不对称性。我们使用学生t检验比较治疗前后的密度值（亨氏单位）。使用《不良事件通用术语标准》第4.0版评估毒性。此外，使用Kaplan-Meier方法计算总生存期。
我们评估了130例多发性骨髓瘤患者（69%为男性；31%为女性），中位年龄为58岁。中位随访期为41个月。治疗前，51%的病变被分类为不稳定。在放疗后3个月和6个月，该比例分别降至41%（P = 0.0047）和24%（P = 0.2393）。计算机断层扫描测量显示放疗后3个月和6个月骨密度显著增加。34%的患者检测到与放疗相关的1级和2级急性并发症。23%的患者检测到晚期副作用（1 - 2级）。未发现严重的3级或4级急性或晚期毒性。所有患者的中位总生存期为19.7个月，卡氏功能状态评分≤70%的患者为6.6个月。
据我们所知，我们的研究是首份使用经过验证的评分系统和计算机断层扫描成像分析放疗后多发性骨髓瘤患者骨密度和稳定性的报告。姑息性放疗是一种有效的方法，可使骨密度显著增加，实现局部反应和稳定性，且无严重的放疗相关毒性。此外，在治疗后3个月即可检测到再钙化。
