Resende Salgado Lucas, Wang Shutao, Adler Ava, Chang Sanders, Ru Meng, Moshier Erin, Dharmarajan Kavita, Jay Cho Hearn, Bakst Richard
Department of Radiation Oncology, Mount Sinai Hospital, New York, New York.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
Adv Radiat Oncol. 2018 Sep 27;4(1):112-117. doi: 10.1016/j.adro.2018.09.009. eCollection 2019 Jan-Mar.
The management of multiple myeloma has evolved in the modern era, partially owing to the increasing number of biologic therapeutics. Nonetheless, radiation remains an important treatment in the management of painful lytic lesions from multiple myeloma. The goal of this study is to evaluate the side effect profile of radiation therapy (RT) while patients are concurrently treated with biologic agents.
We conducted a retrospective study based on data collected from patients receiving RT at our institute from 2007 to 2017. A total of 130 patients (279 treatment sites) were included in this study with a median follow-up time of 14 months. Patients were required to be receiving a biological agent at least within 1 month before starting and up to 1 month after RT. Generalized estimating equations with a log link function and binomial distribution were used to estimate the prevalence ratio (PR) and corresponding 95% confidence interval (CI) and compare the side effects between patients with RT alone and RT + biologic agent.
The median age of all patients in our cohort was 64 years, with 53 men (58.9%) and 37 women (41.1%). The mean Karnofsky performance status score of all cohorts was 80. No significant difference in incidence of acute (PR: 1.33; 95% CI, 0.80-2.22; = .2660) or subacute (PR: 0.90; 95% CI, 0.49-1.67; = .7464) toxicities was found between patients with or without biologic agents who were treated concurrently with RT. No significant difference was found in reduction in laboratory values between patients with or without biologic agents treated concurrently with RT for white blood cells ( = .6916), platelets ( = .7779), or hematocrit ( = .0858).
Our study did not detect any significant toxicity rates from palliative radiation while patients were concurrently treated with biologic agents.
在现代，多发性骨髓瘤的治疗方法不断发展，部分原因是生物治疗药物的数量不断增加。尽管如此，放射治疗仍然是多发性骨髓瘤疼痛性溶骨性病变治疗中的重要手段。本研究的目的是评估患者在接受生物制剂治疗的同时进行放射治疗（RT）的副作用情况。
我们基于2007年至2017年在我院接受放射治疗的患者收集的数据进行了一项回顾性研究。本研究共纳入130例患者（279个治疗部位），中位随访时间为14个月。要求患者在开始放射治疗前至少1个月至放射治疗后1个月内接受生物制剂治疗。采用具有对数链接函数和二项分布的广义估计方程来估计患病率比（PR）和相应的95%置信区间（CI），并比较单纯放射治疗患者与放射治疗+生物制剂患者的副作用。
我们队列中所有患者的中位年龄为64岁，其中男性53例（58.9%），女性37例（41.1%）。所有队列的平均卡诺夫斯基功能状态评分为80分。在同时接受放射治疗的患者中，使用或未使用生物制剂的患者之间，急性毒性（PR：1.33；95%CI，0.80 - 2.22；P = 0.2660）或亚急性毒性（PR：0.90；95%CI，0.49 - 1.67；P = 0.7464）的发生率没有显著差异。在同时接受放射治疗的患者中，使用或未使用生物制剂的患者在白细胞（P = 0.6916）、血小板（P = 0.7779）或血细胞比容（P = 0.0858）的实验室值降低方面没有显著差异。
我们的研究未发现患者在接受生物制剂治疗的同时进行姑息性放射治疗时存在任何显著的毒性率。
