Mark Daniel, Gilbo Philip, Meshrekey Raymond, Ghaly Maged
Department of Radiation Medicine, Northwell Health, Lake Success, NY, United States.
New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, United States.
Front Oncol. 2019 Jul 3;9:601. doi: 10.3389/fonc.2019.00601. eCollection 2019.
The objective of this study was to assess a contemporary cohort of patients with multiple myeloma referred for palliative radiation to the mobile spine for clinical and radiological responses. The records of patients treated between 2009 and 2016 with radiotherapy for multiple myeloma of the spine were retrospectively reviewed. Demographics, systemic therapy, radiation dose, number of fractions, radiographic response based upon adapted RECIST criteria, and symptomatic response were recorded. Eighty eight patients and 98 treatment courses were analyzed. All courses were analyzed for symptomatic response and 61 of the treatment courses were available for radiologic follow-up. The median follow-up was 9.7 months with a median radiation dose of 25 Gy (12.5-50 Gy) delivered in a median of 10 fractions (5-25 fractions). Fifty-four percent of patients had a high-risk lesion. Symptomatic response as measured by a decrease of ≤5 points on the pain related scale was 83% and 34% of patients had a decrease of >5 points. Of 35% of patients that had neurologic impairments prior to treatment, improvement was identified 83% of the time. Radiographic response was noted as 13% complete response, 16% partial response, 57% stable disease, and 13% disease progression. Specifically, high-risk lesions treated with radiation alone demonstrated no regression with only 10% demonstrating partial response. This retrospective series of patients treated with palliative intent for multiple myeloma using various dose and fractionation schemes showed favorable symptomatic relief in most patients. Radiographic response did not correlate with clinical response with fewer patients having radiologic disease regression. Longer follow-up is necessary to determine if the lack of radiologic response is associated with clinically relevant recurrent pain.
本研究的目的是评估一组因转移性脊柱姑息性放疗而转诊的多发性骨髓瘤患者的临床和放射学反应。对2009年至2016年间接受脊柱多发性骨髓瘤放射治疗的患者记录进行回顾性分析。记录患者的人口统计学资料、全身治疗情况、放射剂量、分次次数、基于改良RECIST标准的影像学反应以及症状性反应。分析了88例患者和98个疗程。对所有疗程进行症状性反应分析，其中61个疗程可进行放射学随访。中位随访时间为9.7个月，中位放射剂量为25 Gy（12.5 - 50 Gy），中位分次次数为10次（5 - 25次）。54%的患者有高危病变。以疼痛相关量表评分降低≤5分为标准的症状性反应率为83%，评分降低>5分的患者占34%。在治疗前有神经功能障碍的患者中，83%的患者症状得到改善。影像学反应为完全缓解13%、部分缓解16%、疾病稳定57%、疾病进展13%。具体而言，单纯接受放疗的高危病变无退缩，仅10%表现为部分缓解。这一回顾性系列研究中，采用不同剂量和分割方案对多发性骨髓瘤患者进行姑息性治疗，多数患者症状缓解良好。影像学反应与临床反应不相关，影像学疾病退缩的患者较少。需要更长时间的随访来确定影像学无反应是否与临床相关的复发性疼痛有关。
