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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Ashamalla H, Cardoso E, Macedon M, et al. Phase I trial of vertebral intracavitary Cement and samarium (VICS): novel technique for treatment of painful vertebral metastasis. Int J Radiat Oncol Biol Phys 2009; 75:836–842.
Bayouth JE, Macey DJ, Kasi LP, Fossella FV. Dosimetry and toxicity of samarium-153-EDTMP administered for bone pain due to skeletal metastases. J Nucl Med 1994;35:63–69.
Bone Pain Trial Working Party. 8 Gy single fraction radiotherapy for the treatment of metastatic skeletal pain: randomised comparison with a multifraction schedule over 12 months of patient follow-up. Radiother Oncol 1999;52:111–121.
Bosch A, Frias Z. Radiotherapy in treatment of multiple myeloma. Int J Radiat Oncol Biol Phys 1998;15:1363–1369.
Chang EL, Shiu AS, Mendel E, et al. Phase I/II study of stereotactic body radiotherapy for spinal metastasis and its pattern of failure. J Neurosurg Spine 2007;7:151–160.
Cotten A, Deprez X, Migaud H, Chabanne B, Duquesnoy B, Chastanet P. Malignant acetabularosteolyses: percutaneous injection of acrylic bone cement. Radiology 1995; 197:307–310.
Dean JR, Ison KT, Gishen P. The strengthening effect of percutaneous vertebroplasty. Clin Radiol 2000; 55: 471–476.
Farhangi M, Osserman E. The treatment of multiple myeloma. Semin Hematol 1973;10:149–161.
Galibert P, Deramond H, Rosat P, Le Gars D. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 1987; 33:166–168.
Gerszten PC, Burton SA, Ozhasoglu C, Welch WC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine 2007;32:193–199.
Gerszten PC, Germanwala A, Burton SA, et al. Combination kyphoplasty and spinal radiosurgery: a new treatment paradigm for pathological fractures. J Neurosurg Spine 2005;3:296–301.
Gibbs IC. Spinal and paraspinal lesions: the role of stereotactic body radiotherapy. Front Radiat Ther Oncol 2007;40:407–414.
Hierholzer J, Anselmetti G, Fuchs H, Depriester C, Koch K, Pappert D. Percutaneous osteoplasty as a treatment for painful malignant bone lesions of the pelvis and femur. J Vasc Interv Radiol 2003; 14: 773–777.
Kaasa S, Brenne E, Lund JA, et al. Prospective randomised multicenter trial on single fraction radiotherapy (8 Gy °× 1) versus multiple fractions (3 Gy °× 10) in the treatment of painful bone metastases. Radiother Oncol 2006;79:278–284.
Kawai N, SatoM, Iwamoto T, Tanihata H, Minamiguti H, Nakata K. Percutaneous osteoplasty with use of a cement-filled catheter for a pathologic fracture of the humerus. J Vasc Interv Radiol 2007;18:805–809.
Kelekis A, Lovblad KO, Mehdizade A, et al. Pelvic osteoplasty in osteolytic metastases: technical approach under fluoroscopic guidance and early clinical results. J Vasc Interv Radiol 2005;16:81–88.
Leigh B, Kurtts, Mack C, et al. Radiation therapy for palliation of multiple myeloma. Int J Radiat Oncol Biol Physic 1993;25:801–804.
Nielsen OS, Bentzen SM, Sandberg E, et al. Randomized trial of single dose versus fractionated palliative radiotherapy of bone metastases. Radiother Oncol 1998;47:233–240.
Ryu S, Jin R, Jin JY, et al. Pain control by image-guided radiosurgery for solitary spinal metastasis. J Pain Symptom Manage 2008;35:292–298.
Pommersheim W, Huang-Hellinger F, Baker M, Morris P. Sacroplasty: a treatment for sacral insufficiency fractures. Am J Neuroradiol 2003;24:1003–1007.
Schneider F, Greineck F, Clausen S, et al. Development of a novel method for Intraoperative radiotherapy during kyphoplasty for spinal metastases (kypho-iort). Int J Rad Oncol Biol Phys 2010; Ahead of print. Oct 7
Singh A, Holmes RA, Farhangi M, et al. Human pharmacokinetics of samarium-153 EDTMP in metastatic cancer. J Nucl Med 1989;30:1814–1818.
Steenland E, Leer JW, van Houwelingen H, et al. The effect of a single fraction compared to multiple fractions on painful bone metastases: a global analysis of the Dutch Bone Metastasis Study. Radiother Oncol 1999;52:101–109.
Uemura A, Matsusako M, Numaguchi Y, et al. Percutaneous sacroplasty for hemorrhagic metastases from hepatocellular carcinoma. AJNR Am J Neuroradiol 2005;26:493–495.
Weill A, Kobaiter H, Chiras J. Acetabulum malignancies: technique and impact on pain of percutaneous injection of acrylic surgical cement. Eur Radiol 1998; 8:123–129.
Yamada Y, Bilsky MH, Lovelock DM, et al. High-dose, single-fraction image-guided intensity-modulated radiotherapy for metastatic spinal lesions. Int J Radiat Oncol Biol Phys 2008;71:484–490.
Yamada K, Matsumoto Y, Kita M, et al. Clinical outcome of percutaneous osteoplasty for pain caused by metastatic bone tumors in the pelvis and femur. J Anesth 2007;21:277–281.
Zhou B, Wu CG, Li MH, et al. Percutaneous osteoplasty for painful sternal lesion From multiple myeloma. Skelet Radiol 2009;38:281–285.
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Wernicke, A.G., Sabbas, A., Kulidzhanov, F. et al. A Single-Dose Conformal Delivery of Radiotherapy Following Osteoplasty . HSS Jrnl 8, 169–174 (2012). https://doi.org/10.1007/s11420-011-9213-4
- multiple myeloma
- conformal radiation