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Palliative radiotherapy in patients with multiple myeloma.

PURPOSE
To analyse the therapeutic effect of palliative radiation therapy (RT) in multiple myeloma (MM) patients with bone lesions and soft tissue formations, to compare the therapeutic efficacy of two different RT regimens, the effect of RT on basic disease parameters, and its impact on survival in MM patients.


PATIENTS AND METHODS
162 patients with MM were diagnosed and followed for a 10-year period (1994-2004). Eighty-seven (53.7%) of them with myeloma bone disease (MBD) underwent palliative RT with two different regimens. The effect of RT on MBD and its complications was assessed. Patients with RT were compared in 10 parameters before and after RT. Survival was compared between the irradiated and non irradiated groups and also between patients treated with two different RT regimens, using Kaplan-Meier method and log-rank test.


RESULTS
RT was applied in 92.1% of the patients with vertebral fractures, in 90.9% of the patients with non-vertebral fractures, and in 94.1% of the patients with extramedullary tumor formations. In 89.6% of the patients complete or partial pain palliation was achieved and in 58.6% resolution of neurologic symptoms occurred. The levels of hemoglobin (Hb), white blood cell (WBC) and platelet counts (PLT), bone marrow infiltration, serum calcium (Ca), creatinine, albumin, CRP, LDH, beta2-microglobulin did not change significantly before and after RT. Median survival of patients on RT was 32 months (range 30-34) vs. 33 months (range 28-36) for patients without RT (p>0.05). Median survival was 32 months (range 27-37) for patients on 2x8 Gy. vs. 34 months (range 25-39) for those on 5x4 Gy (p>0.05).


CONCLUSION
RT is a very effective method in bone pain palliation in vertebral and non-vertebral fractures and reduction of extramedullary formations, but does not influence the survival of patients with MM.