Williams Graeme R, Butala Anish A, Manjunath Shwetha H, Maxwell Russell J L, Anstadt Emily J, Waxman Adam J, Jones Joshua A, Plastaras John P, Paydar Ima
Department of Radiation Oncology.
Division of Medical Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
Adv Radiat Oncol. 2021 May 19;6(4):100720. doi: 10.1016/j.adro.2021.100720. eCollection 2021 Jul-Aug.
Myeloma lesions of the head can present with central nervous system (CNS) involvement (leptomeningeal disease or brain metastasis), cranial neuropathy (CN), or impending neurologic involvement (INI). We analyzed response and survival after palliative radiation therapy (RT) to the brain and/or skull for myeloma lesions to determine whether CNS involvement fared worse than other RT indications.
We retrospectively analyzed 54 palliative RT courses administered at our institution from 2008 to 2019. Eleven courses were administered for CNS disease, 28 for CN, and 15 for INI. Demographic, disease, and RT variables were recorded as well as clinical response, radiographic response, and survival. Univariate analyses were performed for differences between groups, effects of clinical and RT treatment factors on response, as well as dose response. Survival was analyzed with the Kaplan-Meier method and compared by the log-rank test.
This heavily pretreated cohort received a median of 20 to 24 Gy, most often to the base of skull, orbit(s), calvarium, or whole brain. Any clinical response (partial or complete vs no response or progressive disease) was significantly more likely for patients with CN and INI when collectively compared with patients with CNS disease ( < .001). Dose response was significant for doses ≥15 and 20 Gy for the whole cohort ( = .026 and .005, respectively) and patients with CN/INI ( = .023 and .002, respectively). Additionally, patients with high-risk cytogenetics were less likely to clinically respond ( = .009). Patients with CNS disease had worse survival ( = .005).
Patients with leptomeningeal disease/brain metastasis have poor clinical response and survival after RT and their responses do not demonstrate a dose response. Given these poor outcomes, the potential benefit of RT may be limited for some patients who may be alternatively managed by supportive care or short RT courses. Patients with CN/INI have longer survival and better response rates and may benefit from RT courses ≥15 to 20 Gy.
骨髓瘤头部病变可表现为中枢神经系统（CNS）受累（软脑膜疾病或脑转移）、颅神经病变（CN）或即将发生的神经受累（INI）。我们分析了针对骨髓瘤病变进行姑息性放疗（RT）至脑和/或颅骨后的反应及生存情况，以确定CNS受累是否比其他RT适应症的预后更差。
我们回顾性分析了2008年至2019年在本机构进行的54例姑息性RT疗程。11例疗程用于CNS疾病，28例用于CN，15例用于INI。记录了人口统计学、疾病和RT变量以及临床反应、影像学反应和生存情况。对组间差异、临床和RT治疗因素对反应的影响以及剂量反应进行单因素分析。采用Kaplan-Meier方法分析生存情况，并通过对数秩检验进行比较。
这个接受过大量预处理的队列接受的中位剂量为20至24 Gy，最常照射的部位是颅底、眼眶、颅骨或全脑。与CNS疾病患者相比，CN和INI患者总体上出现任何临床反应（部分或完全缓解 vs 无反应或疾病进展）的可能性显著更高（<0.001）。对于整个队列（分别为P = 0.026和0.005）以及CN/INI患者（分别为P = 0.023和0.002），剂量≥15 Gy和20 Gy时剂量反应显著。此外，具有高危细胞遗传学特征的患者临床反应的可能性较小（P = 0.009）。CNS疾病患者的生存情况较差（P = 0.005）。
软脑膜疾病/脑转移患者放疗后的临床反应和生存情况较差，且其反应未显示出剂量反应。鉴于这些不良结果，对于一些可能通过支持性治疗或短疗程放疗进行替代管理的患者，放疗的潜在益处可能有限。CN/INI患者的生存时间更长，反应率更好，可能从≥15至20 Gy的放疗疗程中获益。
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