Case Report

HSS Journal ®

, Volume 8, Issue 2, pp 169-174

A Single-Dose Conformal Delivery of Radiotherapy Following Osteoplasty

A Novel Approach to Treatment of Osteolytic Metastasis in the Setting of Multiple Myeloma
  • A. Gabriella WernickeAffiliated withWeill Cornell Medical College Email author 
  • , Albert SabbasAffiliated withWeill Cornell Medical College
  • , Fridon KulidzhanovAffiliated withWeill Cornell Medical College
  • , Michael ShamisAffiliated withDepartment of Medicine, Saint George’s University School of Medicine
  • , Yevgeniya GolsterAffiliated withDepartment of Biological Sciences, Bradeis University
  • , Ruben NiesvizkyAffiliated withDepartment of Hemotology/Oncology, Weill Cornell Medical College
  • , Joseph LaneAffiliated withDepartment of Orthopedic Surgery, Weill Cornell Medical CollegeHospital for Special Surgery

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Abstract

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.

Keywords

multiple myeloma radiotherapy conformal radiation brachytherapy