Price Jeremy G, Niedzwiecki Donna, Oyekunle Taofik, Arcasoy Murat O, Champ Colin E, Kelsey Chris R, Salama Joseph K, Moravan Michael J
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Radiation Oncology Service, Durham VA Medical Health Care System, Durham, North Carolina.
Adv Radiat Oncol. 2021 May 28;6(4):100729. doi: 10.1016/j.adro.2021.100729. eCollection 2021 Jul-Aug.
Osteolytic lesions are present in 75% of patients with multiple myeloma (MM) and frequently require palliation with radiation therapy (RT). Prior case series of patients with MM with bone pain undergoing palliative RT suggests doses ≥12 Gy (equivalent dose in 2Gy fractions, EQD2) provide excellent bone pain relief. However, recent advances in care and novel biologic agents have significantly improved overall survival and quality of life for patients with MM. We hypothesized that lower-dose RT (LDRT, EQD2 <12 Gy) offers an effective alternative to higher-dose RT (HDRT, EQD2 ≥12 Gy) for palliation of painful, uncomplicated MM bone lesions.
We retrospectively identified patients with MM treated with RT for uncomplicated, painful bone lesions and stratified by EQD2 ≥/< 12 Gy. Clinical pain response (CPR) rates, acute and late toxicity, pain response duration, and retreatment rates between LDRT and HDRT groups were analyzed.
Thirty-five patients with 70 treated lesions were included: 24 patients (48 lesions) treated with HDRT and 11 patients (22 lesions) with LDRT. Median follow-up was 14 and 16.89 months for HDRT and LDRT, respectively. The median dose of HDRT treatment was 20 Gy versus 4 Gy in the LDRT group. The CPR rate was 98% for HDRT and 95% for LDRT. There was no significant difference in any-grade acute toxicity between the HDRT and LDRT cohorts (24.5% vs 9.1%, Χ = .20). Pain recurred in 10% of lesions (12% HDRT vs 9.5% LDRT). Median duration of pain response did not significantly differ between cohorts ( = .91). Five lesions were retreated, 2 (9.5%) in the LDRT cohort, and 3 (6.3%) in the HDRT cohort.
In this study, LDRT effectively palliated painful, uncomplicated MM bony lesions with acceptable CPR and duration of palliation. These data support prospective comparisons of LDRT versus HDRT for palliation of painful, uncomplicated MM bony lesions.
75%的多发性骨髓瘤（MM）患者存在溶骨性病变，常需接受放射治疗（RT）以缓解症状。先前关于患有骨痛的MM患者接受姑息性RT的病例系列研究表明，剂量≥12 Gy（2 Gy分割等效剂量，EQD2）能有效缓解骨痛。然而，近年来护理方面的进展和新型生物制剂显著提高了MM患者的总生存期和生活质量。我们推测，低剂量RT（LDRT，EQD2<12 Gy）可为缓解疼痛且无并发症的MM骨病变提供一种有效的替代高剂量RT（HDRT，EQD2≥12 Gy）的方法。
我们回顾性地确定了因无并发症的疼痛性骨病变接受RT治疗的MM患者，并根据EQD2≥/<12 Gy进行分层。分析了LDRT组和HDRT组之间的临床疼痛缓解率（CPR）、急性和晚期毒性、疼痛缓解持续时间以及再次治疗率。
共纳入35例患者，70处病变接受治疗：24例患者（48处病变）接受HDRT治疗，11例患者（22处病变）接受LDRT治疗。HDRT组和LDRT组的中位随访时间分别为14个月和16.89个月。HDRT治疗的中位剂量为20 Gy，而LDRT组为4 Gy。HDRT组的CPR率为98%，LDRT组为95%。HDRT组和LDRT组之间任何级别的急性毒性均无显著差异（24.5%对9.1%，Χ²=0.20）。10%的病变疼痛复发（HDRT组为12%，LDRT组为9.5%）。各队列之间疼痛缓解的中位持续时间无显著差异（P=0.91）。5处病变接受了再次治疗，LDRT组2处（9.5%），HDRT组3处（6.3%）。
在本研究中，LDRT有效地缓解了疼痛且无并发症的MM骨病变，CPR和缓解持续时间均可接受。这些数据支持对LDRT与HDRT缓解疼痛且无并发症的MM骨病变进行前瞻性比较。
