A Single-Dose Conformal Delivery of Radiotherapy Following Osteoplasty
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Multiple myeloma (MM) is a very radiosensitive tumor. Fractionated external beam radiation, which takes approximately 2 weeks of therapy, is typically used to irradiate myelomatous bone lesions with the goal of palliation. However, traditional radiotherapeutic techniques are not only lengthy but they also involve a considerable amount of healthy bone marrow in the treatment ports, which may undermine the total marrow reserve of a patient. Because of the limited survival time of patients with metastatic cancer, novel treatment concepts shortening the overall treatment time is desirable. We present an innovative approach of delivering targeted intra-operative radiotherapy to a solitary osteolytic metastasis in one application, while sparing healthy bone marrow from radiation toxicity and substantially reducing the overall treatment time. A 78-year-old Caucasian male with MM, previously treated with chemotherapy, who was off chemotherapy for 2 years due to bone marrow suppression, presented with a solitary recurrence at the left anterior superior iliac spine of the left iliac wing as diagnosed by PET-CT scan. This lesion was treated with a minimally invasive osteoplasty and intra-operative brachytherapy with to a dose of 8 Gy delivered to the surgical cavity only, followed by injection of the bone cement into the cavity. Three months after the procedure, the area of treatment demonstrated no uptake on a follow-up PET-CT scan. At 1.5 years after this procedure, 100% local control continues to persist in the treated area, as evidenced on nuclear imaging. To our knowledge, this is the first case of using focal intra-operative brachytherapy confined to the area of the pelvis in a patient treated for a solitary metastasis from MM. The purpose of the article is to present a novel approach as a more convenient and focal treatment of bony lesions of MM.
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- A Single-Dose Conformal Delivery of Radiotherapy Following Osteoplasty
HSS Journal ®
Volume 8, Issue 2 , pp 169-174
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- multiple myeloma
- conformal radiation
- Author Affiliations
- 1. Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10065, USA
- 2. Department of Medicine, Saint George’s University School of Medicine, Grenada, WI, USA
- 3. Department of Biological Sciences, Bradeis University, Waltham, MA, USA
- 4. Department of Hemotology/Oncology, Weill Cornell Medical College, New York, NY, 10065, USA
- 5. Department of Orthopedic Surgery, Weill Cornell Medical College, New York, NY, 10065, USA
- 6. Hospital for Special Surgery, New York, NY, 10021, USA