Leigh B R, Kurtts T A, Mack C F, Matzner M B, Shimm D S
Department of Radiation Oncology, University of Arizona College of Medicine and Cancer Center, Tucson 85724.
Int J Radiat Oncol Biol Phys. 1993 Apr 2;25(5):801-4. doi: 10.1016/0360-3016(93)90308-i.
This reviews the experience at the University of Arizona in an effort to define the minimum effective radiation dose for durable pain relief in the majority of patients with symptomatic multiple myeloma.
The records of 101 patients with multiple myeloma irradiated for palliation at the University of Arizona between 1975 and 1990 were reviewed. Three hundred sixteen sites were treated. Ten sites were asymptomatic, including six hemibody fields with advanced disease unresponsive to chemotherapy and four local fields with impending pathological fractures. Three hundred six evaluable symptomatic sites remained. The most common symptom was bone pain. Other symptoms included neurological impairment and a palpable mass.
Total tumor dose ranged from 3.0 to 60 Gy, with a mean of 25 Gy. Symptom relief was obtained in 297 of 306 evaluable symptomatic sites (97%). Complete relief of symptoms was obtained in 26% and partial relief in 71%. Symptom relief was obtained in 92% of sites receiving a total dose less than 10 Gy (n = 13) and 98% of sites receiving 10 Gy or more (n = 293). No dose-response could be demonstrated. The likelihood of symptom relief was not influenced by the location of the lesion or the use of concurrent chemotherapy. Of the 297 responding sites, 6% (n = 19) relapsed after a median symptom-free interval of 16 months. Neither the probability of relapse nor the time to relapse was related to the radiation dose. Retreatment of relapsing sites provided effective palliation in all cases.
Radiation therapy is effective in palliating local symptoms in multiple myeloma. A total dose of 10 Gy should provide durable symptom relief in the majority of patients.
回顾亚利桑那大学的经验，以确定对大多数有症状的多发性骨髓瘤患者实现持久疼痛缓解的最低有效辐射剂量。
回顾了1975年至1990年间在亚利桑那大学接受姑息性放疗的101例多发性骨髓瘤患者的记录。共治疗了316个部位。10个部位无症状，包括6个对化疗无反应的晚期疾病半身野和4个有即将发生病理性骨折的局部野。其余306个可评估的有症状部位。最常见的症状是骨痛。其他症状包括神经功能损害和可触及的肿块。
总肿瘤剂量范围为3.0至60 Gy，平均为25 Gy。306个可评估的有症状部位中的297个（97%）症状得到缓解。26%的症状完全缓解，71%部分缓解。总剂量小于10 Gy的部位（n = 13）中有92%症状得到缓解，总剂量为10 Gy或更高的部位（n = 293）中有98%症状得到缓解。未显示出剂量反应关系。症状缓解的可能性不受病变部位或同时使用化疗的影响。在297个有反应的部位中，6%（n = 19）在中位无症状间隔16个月后复发。复发概率和复发时间均与辐射剂量无关。复发部位的再次治疗在所有病例中均提供了有效的姑息治疗。
放射治疗对缓解多发性骨髓瘤的局部症状有效。10 Gy的总剂量应能使大多数患者获得持久的症状缓解。
