title: Volumetric modulated arc radiotherapy for limited osteosclerotic myeloma.
abstract: OBJECTIVE
  To assess the feasibility of volumetric intensity-modulated arc radiotherapy (VMAT) in patients with limited polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome.
  
  
  METHODS
  A 70-year-old male with histologically confirmed osteosclerotic myeloma was treated in our department in July 2010 with VMAT. Fourty-six Gray in 23 fractions were given on three bone lesions. Doses delivered to target volume and critical organs were compared with a tridimensional conformal radiotherapy (3D-RT) plan. Treatment was well tolerated without any side effects.
  
  
  RESULTS
  VMAT improved dose homogeneity within the target volume, as compared to 3D-RT (standard deviations: 2.9 Gy and 1.6 Gy for 3D and VMAT, respectively). VMAT resulted in a better sparing of critical organs. Dose delivered to 20% of organ volume (D20) was reduced from 22 Gy (3D-RT) to 15 Gy (VMAT) for small bowel, from 24 Gy (3D-RT) to 17 Gy (VMAT) for bladder and from 47 Gy (3D-RT) to 3 Gy (VMAT) for spinal cord. Volumes of critical organs that received at least 20 Gy (V20) were decreased by the use of VMAT, as compared to 3D-RT (V20 bladder: 10% vs 99%; V20 small bowel: 6% vs 21%). One year after treatment completion, no tumor progression has been reported.
  
  
  CONCLUSIONS
  VMAT improved dose distribution as compared to 3D-RT for limited osteosclerotic myeloma, with better saving of critical organs.
authors.affiliation: Aurélie Robles, Coralie Moncharmont, Lamine Farid, Jean-Baptiste Guy, Nadia Malkoun, Lysian Cartier, Jean-Noël Talabard, Guy de Laroche, Nicolas Magné, Department of Radiotherapy, Institut de Cancérologie de la Loire, 42270 St Priest en Jarez, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Robles
authors.forename: Antonin
authors.initials: A
authors.lastname: Levy
authors.forename: Coralie
authors.initials: C
authors.lastname: Moncharmont
authors.forename: Lamine
authors.initials: L
authors.lastname: Farid
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Guy
authors.forename: Nadia
authors.initials: N
authors.lastname: Malkoun
authors.forename: Lysian
authors.initials: L
authors.lastname: Cartier
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.forename: Isabelle
authors.initials: I
authors.lastname: Guichard
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Talabard
authors.forename: Guy
authors.initials: G
authors.lastname: de Laroche
authors.forename: Nicolas
authors.initials: N
authors.lastname: Magné
keywords: Conformal radiotherapy; Critical organs; Osteosclerotic myeloma; Polyneuropathy organomegaly endocrinopathy monoclonal gammopathy and skin change syndrome; Volumetric intensity-modulated arc radiotherapy