title: A single-dose conformal delivery of radiotherapy following osteoplasty : a novel approach to treatment of osteolytic metastasis in the setting of multiple myeloma.
abstract: 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.
authors.affiliation: Weill Cornell Medical College, 525 East 68th Street, New York, NY 10065 USA.
authors.forename: A Gabriella
authors.initials: AG
authors.lastname: Wernicke
authors.forename: Albert
authors.initials: A
authors.lastname: Sabbas
authors.forename: Fridon
authors.initials: F
authors.lastname: Kulidzhanov
authors.forename: Michael
authors.initials: M
authors.lastname: Shamis
authors.forename: Yevgeniya
authors.initials: Y
authors.lastname: Golster
authors.forename: Ruben
authors.initials: R
authors.lastname: Niesvizky
authors.forename: Joseph
authors.initials: J
authors.lastname: Lane
keywords: brachytherapy; conformal radiation; multiple myeloma; radiotherapy