Department of Radiation Oncology, University Medical Center Mainz, Mainz, Germany.
Department for Radiation Oncology, Charité-Universitätsmedizin Berlin, 13353, Berlin, Germany.
Strahlenther Onkol. 2024 Jul;200(7):633-641. doi: 10.1007/s00066-024-02198-7. Epub 2024 Jan 30.
Multiple myeloma is associated with osteolytic bone lesions, often requiring surgery of the spine and postoperative radiotherapy (RT). Although common, data for clinical and informed decision-making are sparse. In this monocentric retrospective study, we aim to report the outcome of patients who underwent spinal surgery and postoperative RT due to multiple myeloma.
A total of 54 patients with multiple myeloma who underwent prior spinal surgery and postoperative RT at our institution between 2009 and 2020 were analyzed. Spinal instability neoplastic score (SINS) and Bilsky score, posttherapeutic adverse events, clinical data, and outcomes were collected and analyzed. The primary endpoint of this study was overall survival (OS), secondary endpoints were progression-free survival (PFS), pain response, local control, and skeletal-related events (SRE).
The 3‑ and 5‑year overall survival (OS) was 74.9% (95% confidence interval [CI]: 63.5-88.4%) and 58% (95% CI: 44.5-75.6%), respectively. Median survival was not reached and 75% survival was 34.3 months (95% CI: 28.7-95.4 months). Median follow-up was 63 months (95% CI: 49-94 months). The number of patients with good to adequate performance status (Karnofsky performance score [KPS] ≥ 70) significantly increased after surgery (p < 0.01). We observed no grade 3/4 toxicity and only 13 (24%) grade 1/2 adverse events. Two patients (4%) experienced SRE. Overall, 92% of patients reported reduced pain after radiotherapy, with 66% reporting complete pain response. There was no difference in pain response between patients with different Bilsky scores. Bisphosphonate therapy and lower Bilsky score at the start of RT were associated with improved OS in univariate analysis (all p < 0.05). Multivariate Cox regression confirmed a Bilsky score of 2 or 3 as an independent negative prognostic factor (HR 3.89; 95 CI 1.4-10.7; p < 0.01). We observed no in-field recurrences.
In this study, we were able to show that the current standard of RT after spinal surgery of osteolytic lesions is safe. In addition, we observed a very low rate of SRE (4%) and no in-field recurrences, demonstrating the local efficacy of RT in multiple myeloma patients. Higher Bilsky scores were associated with worse OS in multivariate analysis, but had no effect on pain response.
多发性骨髓瘤常伴有溶骨性骨病变，往往需要脊柱手术和术后放疗（RT）。尽管这种情况很常见，但关于临床和知情决策的数据却很少。在这项单中心回顾性研究中，我们旨在报告因多发性骨髓瘤在我院接受脊柱手术和术后 RT 的患者的治疗结果。
我们分析了 2009 年至 2020 年间在我院因多发性骨髓瘤接受过脊柱手术和术后 RT 的 54 例患者。收集并分析了脊柱不稳定肿瘤评分（SINS）和 Bilsky 评分、治疗后不良事件、临床数据和结果。本研究的主要终点是总生存率（OS），次要终点是无进展生存率（PFS）、疼痛缓解、局部控制和骨骼相关事件（SRE）。
3 年和 5 年总生存率（OS）分别为 74.9%（95%置信区间[CI]：63.5-88.4%）和 58%（95%CI：44.5-75.6%）。中位生存期未达到，75%生存率为 34.3 个月（95%CI：28.7-95.4 个月）。中位随访时间为 63 个月（95%CI：49-94 个月）。术后患者的良好至充分表现状态（Karnofsky 表现评分[KPS]≥70）比例显著增加（p<0.01）。我们观察到没有 3/4 级毒性，只有 13 例（24%）1/2 级不良事件。2 例（4%）患者发生 SRE。总体而言，92%的患者报告放疗后疼痛减轻，66%的患者报告完全疼痛缓解。不同 Bilsky 评分患者的疼痛缓解率无差异。在单因素分析中，双膦酸盐治疗和 RT 开始时较低的 Bilsky 评分与 OS 改善相关（均 p<0.05）。多因素 Cox 回归证实 Bilsky 评分为 2 或 3 是独立的预后不良因素（HR 3.89；95%CI 1.4-10.7；p<0.01）。我们未观察到场内复发。
在这项研究中，我们能够表明，目前溶骨性病变脊柱手术后 RT 的标准是安全的。此外，我们观察到 SRE 发生率非常低（4%），无场内复发，表明 RT 在多发性骨髓瘤患者中的局部疗效。多因素分析中较高的 Bilsky 评分与较差的 OS 相关，但对疼痛缓解无影响。
