Stereotactic radiosurgery for multiple myeloma of the spine
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The aim of this retrospective analysis is to evaluate the role of stereotactic radiosurgery (SRS) in treating multiple myeloma (MM) of the spine.
Medical records of MM patients who underwent single fraction spine SRS between 6/2001 and 12/2014 at our institution were retrospectively reviewed in this institutional review board-approved analysis. Post-treatment radiographic, neurologic, and pain response were the primary endpoints. Endpoints were evaluated with periodic clinical exams and imaging studies (magnetic resonance imaging and computed tomography).
Median SRS dose was 16 Gy (10–18) in a single fraction. Seventy-eight patients (121 treatment sites) were treated. Clinical follow-up was available for 71 patients. Radiographic follow-up was available for 94 treatment sites. Median follow-up was 27.8 months (24 days–12.1 years). Radiographic control was observed in 89.4% of the treated sites. Pain relief occurred in 88.3% of the patients that presented with pain; pain progression occurred in 3.3%. Neurological improvement was observed in 63.6% of the patients that presented with a deficit. In sites where MM approached or compressed the epidural canal or the thecal sac, after SRS, evidence of radiographic regression was observed in 87.1%. Toxicities observed included one patient who experienced a tracheoesophageal fistula 2 years after SRS. After SRS, there were 39 VCFs that were potentially SRS-induced.
SRS appears to be effective in the treatment of MM of the spine. To the best of our knowledge, this is the largest such experience reported.
KeywordsMultiple myeloma Stereotactic radiosurgery Spine
An abstract of a variation of this paper was previously presented as a poster at the American Society of Therapeutic Radiation Oncology 57th Annual Meeting in San Antonio, TX, October 18–21, 2015. The abstract was published in the conference proceedings (Elibe E, Boyce-Fappiano D, Ryu S, Siddiqui MSU, Wen N, Lee I, et al.: Efficacy of spine stereotactic radiosurgery for multiple myeloma epidural cord compression. Int J Radiat Oncol Biol Phys: 93(3):E456, 2015).
Compliance with ethical standards
Dr. M. Salim Siddiqui, Dr. Ning Wen, and Dr. Farzan Siddiqui are employed by the Henry Ford Hospital Department of Radiation Oncology. The Henry Ford Hospital Department of Radiation Oncology receives research funding from Philips Medical and Varian Medical Systems, Inc. entitled “SRS Education and Research Grant” grant number M60287. The funding sources had no direct involvement with the content or analysis of the material presented in this manuscript.
Conflict of interest
Dr. Ian Lee serves as a consultant for Medtronic and a speaker honorarium for Varian Medical Systems, Inc. For the remaining authors (Ms. Erinma Elibe, Dr. David Boyce-Fappiano, Dr. Samuel Ryu, and Dr. Jack Rock), no conflict of interest was declared.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this type of study, formal consent is not required.
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