Strahlentherapie und Onkologie

, Volume 187, Issue 2, pp 114–119 | Cite as

Impact of Radiotherapy on Pain Relief and Recalcification in Plasma Cell Neoplasms

Long-Term Experience
  • Mario Balducci
  • Silvia ChiesaEmail author
  • Stefania Manfrida
  • Elena Rossi
  • Tommaso Za
  • Vincenzo Frascino
  • Berardino De Bari
  • Stefan Hohaus
  • Francesco Cellini
  • Giovanna Mantini
  • Giuseppe Roberto D’Agostino
  • Maria Antonietta Gambacorta
  • Antonello Leone
  • Vincenzo Valentini
  • Valerio De Stefano
Original Article


To evaluate the impact of radiotherapy on pain relief and on recalcification in patients with osteolytic lesions due to plasma cell neoplasm.

Patients and Methods:

Pain relief was evaluated according to a 0–10 verbal numerical rating scale (NRS) and recalcification was measured using radiological imaging.


From 1996–2007, 52 patients were treated (Table 1). Median total dose was 38 Gy (range, 16–50 Gy). Pain be-fore radiotherapy was reported by 45 of 52 (86.5%) patients (Table 2) as being severe (8 ≤ NRS ≤ 10) in 5 (11%), moderate (5 ≤ NRS ≤ 7) in 27 (60%), and mild in 13 (29%). Pain relief was achieved in 41 of 45 patients (91%): complete relief was ob-tained in 21 (51.2%) and partial relief in 20 patients (48.8%); patients with severe pain experienced resolution and none present-ed an increase of pain. Drugs reduction/suspension was achieved in 7 of the 21 patients with complete response. Of 42 patients evaluable for recalcification (Table 3), 21 (50%) presented a radiological response, which was identified as complete in 16 (38%).


Our data confirm the effectiveness of radiotherapy for pain relief, including a reduction in drug intake, and on recalcification, thus, supporting its use in a multidisciplinary approach.

Key Words:

Plasma cell neoplasm Radiotherapy Pain relief Recalcification 

Wirkung der Strahlentherapie auf Schmerzlinderung und Rekalzifizierung beim Multiplen Myelom und Plasmozytom: Langzeit-Erfahrung


Beurteilung der Wirkung der Strahlentherapie auf Schmerzlinderung und Rekalzifizierung bei Patienten mit Osteolysen auf Grund von malignen Plasmazellerkrankungen.

Patienten und Methodik:

Die Schmerzlinderung wurde anhand einer 0–10 numerischen Verbalskala (NVS) beurteilt, während die Rekalzifizierungsrate mittels radiologischer bildgebender Verfahren gemessen wurde.


Von 1996 bis 2007 wurden 52 Patienten behandelt (Tabelle 1). Die mittlere Bestrahlungsdosis betrug 38 Gy (range 16–50 Gy). Schmerzen wurden vor der Strahlentherapie von 45 der 52 (86,5%) Patienten beurteilt (Tablle 2): als schwer (8 ≤ NVS ≤ 10) von 5 (11%), als mittelgradig (5 ≤ NRS ≤ 7) von 27 (60%) und als leicht von 13/45 (29%). Eine Schmerzlinderung wurde bei 41 der 45 (91%) Patienten erreicht: eine vollständige Schmerzkontrolle bei 21 (51,2%) und eine teilweise Linderung bei 20 Patienten (48,8%); alle Patienten mit ausgeprägter Schmerzsymptomatik erfuhren eine Reduktion der Schmerzen, und bei keinem Patienten nahmen die Schmerzen zu. Die Schmerzmedikation konnte bei 7/21 Patienten mit vollständiger Schmerzkontrolle verringert oder abgesetzt werden. Eine Rekalzifizierung wurde bei 42 Patienten radiologisch beurteilt (Tabelle 3): 21 (50%) zeigten eine Verbesserung, eine komplette Rekalzifizierung wurde bei 16 (38%) Patienten beobachtet.


Unsere Daten bestätigen die Wirksamkeit der Strahlentherapie, die in einer multidisziplinären Strategie bei malignen Plasmazellerkrankungen eingesetzt werden kann, um eine Schmerzlinderung mit Reduzierung der Schmerzmittelmedikation und eine Rekalzifizierung zu erreichen.


Multiples Myelom Plasmozytom Strahlentherapie Scherzlinderung Rekalzifizierung 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Adamietz IA, Schober C, Schulte RW, et al. Palliative radiotherapy in plasma cell myeloma. Radiother Oncol 1991;20:111–6CrossRefPubMedGoogle Scholar
  2. 2.
    Berenson JR , Hillner BE, Kyle RA, et al. American Society of Clinical Oncol-ogy Bisphosphonates Expert Panel American Society of Clinical Oncology Clinical Practice Guidelines: The Role of Bisphosphonates in Multiple My-eloma. J Clin Oncol 2002;20:3719–36CrossRefPubMedGoogle Scholar
  3. 3.
    Bone Pain Trial Working Party. 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a mul-tifraction schedule over 12 months of patient follow-up. Radiother Oncol 1999;52:111–21Google Scholar
  4. 4.
    Bruno B, Boccadoro M, Palombo A, et al. Mieloma multiplo e neoplasie plas-macellulari. In: Bonadonna G (ed) Medicina Oncologica, 7th edn. Milano, Masson, 2003:1441–8Google Scholar
  5. 5.
    Chak LY, Cox RS, Bostwick DG, et al. Solitary plasmacytoma of bone: treat-ment, progression, and survival. J Clin Oncol 1987;5:1811–5PubMedGoogle Scholar
  6. 6.
    Chow E, Doyle M, Li K, et al. Mild, moderate or severe pain categorized by patients with cancer with bone metastases. J of Pall Medicine 2006; 9:850–4CrossRefGoogle Scholar
  7. 7.
    Chow E, Hoskin PJ, Wu J, et al. A phase III International randomised trial comparing single with multiple fraction for Re-irradiation of Painful Bone Metastases: National Cancer Institute of Canada Clinical Trials Grops (NCIC CTG) SC 20. Clin Oncol 2006;18:125–8CrossRefGoogle Scholar
  8. 8.
    Chow E, Wu JS, Hoskin P, et al. International consensus on palliative radio-therapy endpoints for future clinical trials in bone metastases. Radiother Oncol 2002;64:275–80CrossRefPubMedGoogle Scholar
  9. 9.
    Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inven-tory. Ann Acad Med Singapore 1994;23:129–38PubMedGoogle Scholar
  10. 10.
    Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev 2001;27:165–76CrossRefPubMedGoogle Scholar
  11. 11.
    Cox JD, Stetz J, Pajak TF et al. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31:1341–6CrossRefPubMedGoogle Scholar
  12. 12.
    Criteria for the classification of monoclonal gammopathies multiple myeloma and related disorders: a report of the International Myeloma Working Group Br J Haematol 2003;121:749–57Google Scholar
  13. 13.
    Dores GM, Landgren O, McGlynn KA, et al. Plasmocytoma of bone, extramedullary plasmocytoma, and multile myeloma : incidence and survival in the United States, 1992–2004. Br J Haematol 2008;144:86–94CrossRefPubMedGoogle Scholar
  14. 14.
    Frassica D, Frassica FJ, Schray MF, et al. Solitary plasmacytoma of bone: Mayo Clinic experience. Int J Radiat Oncol Biol Phys 1989;16:43–8CrossRefPubMedGoogle Scholar
  15. 15.
    Freundt K, Meyners T, Bajrovic A, et al. Radiotherapy for oligometastatic disease in patients with spinal cord compression (MSCC) from relatively adioresistant tumors. Strahlenther Onkol 2010;186:218–23CrossRefPubMedGoogle Scholar
  16. 16.
    Gertz MA, Chen MG (2007) Multiple myeloma and other plasma cell neo-plasms. In: Gunderson LL (ed) Clinical Radiation Oncology. 2nd edn, Phila-delphia: Churchill Levingstone Elsevier 2007:1753–72Google Scholar
  17. 17.
    International Commission on Radiation Units and Measurements. ICRU Report 50. Prescribing, recording, and reporting photon beam therapy. Bethesda, MD: ICRU, 1993Google Scholar
  18. 18.
    International Commission on Radiation Units and Measurements. ICRU Report 62. Prescribing, recording, and reporting photon beam therapy (Supplement to ICRU Report 50). Bethesda, MD: ICRU, 1999Google Scholar
  19. 19.
    Wu JS-Y, Wong R, Johnston M, Bezjak A, et al. Meta-analysis of dose-frac-tionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys 2003;55:594–605CrossRefPubMedGoogle Scholar
  20. 20.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observation. J Am Stat Assoc 1958;53:457–81CrossRefGoogle Scholar
  21. 21.
    Kowing S, Budach V. Remineralization and pain relief in bone metastases after different radiotherapy fractions (10 times 3 Gy vs. 1 time 8 Gy). A prospective study. Strahlenther Onkol 1999;175:500–8CrossRefGoogle Scholar
  22. 22.
    Leigh BR, Kurtts TA, Mack CF, et al. Radiation therapy for the palliation of multiple myeloma. Int J Radiat Oncol Biol Phys 1993;25:801–4CrossRefPubMedGoogle Scholar
  23. 23.
    Mill WB, Griffith R. The role of radiation therapy in the management of plasma cell tumours. Cancer 1980;45:647–652CrossRefPubMedGoogle Scholar
  24. 24.
    Momm F, Lingg S, Xander C, et al. The situation of radiation oncology pa-tients’ relatives. A stocktaking. Strahlenther Onkol 2010;186(6):344–50CrossRefPubMedGoogle Scholar
  25. 25.
    Mose S, Pfitzener D, Rahn A, et al. Role of radiotherapy in the treatment of multiple myeloma. Strahlenther Onkol 2000;176:506–12CrossRefPubMedGoogle Scholar
  26. 26.
    Mücke R, Seegenschmiedt MH, Heyd R, et al. Radiotherapy in painful gon-arthrosis. Results of a national patterns-of-care study. Strahlenther Onkol 2010;186:7–17CrossRefPubMedGoogle Scholar
  27. 27.
    Munshi NC, Tricot G, Barlogie B. Plasma cell neoplasm. In: De Vita VT (ed) Principles and Practice of Oncology, 6th edn, Lippincott Williams & Wilkins Publishers, 2001:1816–37Google Scholar
  28. 28.
    Perez CA, Brady LW, Halperin EC, et al. Principles and Practice of Radia-tion Oncology, Fourth Edition. Philadelphia PA, Lippincott Williams and Wilkins, 2004Google Scholar
  29. 29.
    Roos DE, Turner SL, O’Brien PC, et al. TROG 96.05 Randomized trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (Trans-Tasman Radiation Oncology Group, TROG 96.05) Radiother Oncol 2005;75(1):54–63CrossRefPubMedGoogle Scholar
  30. 30.
    Stolting T, Knauerhase H, Klautke G, et al. Total and single doses influence the effectiveness of radiotherapy in palliative treatment of palsmocytoma. Strahlenther Onkol 2008;184:465–72CrossRefPubMedGoogle Scholar
  31. 31.
    Souchon R, Wenz F, Sedlmayer F, et al. DEGRO practice guidelines for palliative radiotherapy of metastatic breast cancer: bone metastases and metastatic spinal cord compression (MSCC). Strahlenther Onkol 2009;185(7):417–24CrossRefPubMedGoogle Scholar
  32. 32.
    Vakaet LA, Boteberg T. Pain control by ionizing radiation of bone metasta-sis. Int J Dev Biol Phys 2004;48:599–606CrossRefGoogle Scholar
  33. 33.
    Van Der Linden YM, Lok JJ, Steenland E, et al. Single fraction radiother-apy is efficacious: a further analysis of the Dutch Bone Metastasis Study controlling for the influence of retreatment. Int J Radiat Oncol Biol Phys 2004;59:528–37CrossRefPubMedGoogle Scholar
  34. 34.
    Vassiliou V, Tselis N, Kardamakis D. Osteonecrosis of the jaws: clinicopatho-logic and radiologic characteristics, preventive and therapeutic strategies. Strahlenther Onkol 2010;186:367–73CrossRefPubMedGoogle Scholar

Copyright information

© Urban & Vogel, Muenchen 2010

Authors and Affiliations

  • Mario Balducci
    • 1
  • Silvia Chiesa
    • 1
    • 6
    Email author
  • Stefania Manfrida
    • 1
  • Elena Rossi
    • 2
  • Tommaso Za
    • 2
  • Vincenzo Frascino
    • 1
  • Berardino De Bari
    • 3
  • Stefan Hohaus
    • 2
  • Francesco Cellini
    • 4
  • Giovanna Mantini
    • 1
  • Giuseppe Roberto D’Agostino
    • 1
  • Maria Antonietta Gambacorta
    • 1
  • Antonello Leone
    • 5
  • Vincenzo Valentini
    • 1
  • Valerio De Stefano
    • 2
  1. 1.Radiotherapy DepartmentUniversity Hospital “Gemelli”RomeItaly
  2. 2.Hematology DepartmentUniversity Hospital “Gemelli”RomeItaly
  3. 3.Radiotherapy Oncology DepartmentUniversity Hospital Lyon Sud, Pierre BeniteLyon SudFrance
  4. 4.Radiotherapy DepartmentUniversity Hospital “Campus Biomedico”RomeItaly
  5. 5.Radiology DepartmentUniversity Hospital “Gemelli”RomeItaly
  6. 6.Radiotherapy DepartmentUniversity Hospital “Gemelli”RomeItaly

Personalised recommendations