title: Effects of Radiotherapy in the treatment of multiple myeloma: a retrospective analysis of a Single Institution.
abstract: BACKGROUND
  Palliative irradiation of osteolytic lesions is a considerable component in the treatment for patients with multiple myeloma. In this study, we analyzed the efficacy of irradiation in these patients.
  
  
  METHODS
  We retrospectively analyzed 153 patients with multiple myeloma who were admitted to our department between 1989 and 2013. According to the staging system of Durie & Salmon 116 patients were classified as stage III. 107/153 patients were treated with radiotherapy of at least one and up to 6 bony lesions at different times. In order to evaluate the effect of local radiotherapy on pain relief and bone recalcification a uni- and multivariate analysis was performed using a binary logistic regression model to correct for multiple measurements. Complete information on dose, fractionation and volume of radiotherapy was available from 81 patients treated in 136 target volumes for pain relief, and from 69 patients treated in 108 target volumes for recalcification. Total radiation doses varied between 8 Gy to 50 Gy (median dose 25 Gy in 2.5 Gy fractions, 5 times a week).
  
  
  RESULTS
  Radiotherapy resulted in complete local pain relief in 31% and partial local pain relief in 54% of the patients. In the univariate analysis, higher total radiation doses (p = 0.023) and higher age (p = 0.014) at the time of radiotherapy were significantly associated with a higher likelihood of pain relief, whereas no significant association was detected for concurrent systemic treatment, type and stage of myeloma and location of bone lesions. The same variables were independent predictors for pain relief in the multivariate analysis. Recalcification was observed in 48% of irradiated bone lesions. In the uni- and multivariate analysis higher radiation doses were significantly associated (p = 0.048) with an increased likelihood of recalcification. Side effects of radiotherapy were generally mild.
  
  
  CONCLUSIONS
  Higher total biological radiation doses were associated with better pain relief and recalcification in this retrospective evaluation of multiple myeloma patients. In addition, in the elderly the therapeutic measures appear to develop a better analgesic effect.
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. matuschek@med.uni-duesseldorf.de.
authors.forename: Christiane
authors.initials: C
authors.lastname: Matuschek
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. Thomas-A.Ochtrop@t-online.de.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Ochtrop
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. boelke@med.uni-duesseldorf.de.
authors.forename: Edwin
authors.initials: E
authors.lastname: Bölke
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, University of Munich (LMU), Munich, Germany. ute.Ganswindt@med.uni-muenchen.de.
authors.forename: Ute
authors.initials: U
authors.lastname: Ganswindt
authors.affiliation: Department of Hematology Oncology and Clinical Immunology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany. fenk@med.uni-duesseldorf.de.
authors.forename: Roland
authors.initials: R
authors.lastname: Fenk
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. gripp@uni-duesseldorf.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Gripp
authors.affiliation: Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany. Patric.Kroepil@med.uni-duesseldorf.de.
authors.forename: Patric
authors.initials: P
authors.lastname: Kröpil
authors.affiliation: Department of Dermatology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany. PeterArne.Gerber@med.uni-duesseldorf.de.
authors.forename: Peter Arne
authors.initials: PA
authors.lastname: Gerber
authors.affiliation: Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. kkammers@jhsph.edu.
authors.forename: Kai
authors.initials: K
authors.lastname: Kammers
authors.affiliation: Faculty of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. jackson.jake@gmail.com.
authors.forename: Jackson
authors.initials: J
authors.lastname: Hamilton
authors.affiliation: Department of General, Medical Faculty, Visceral, and Thoracic Surgery, Asklepios Harz Hospitals, Goslar, Germany. klausorth@gmx.de.
authors.forename: Klaus
authors.initials: K
authors.lastname: Orth
authors.affiliation: Department of Radiation Oncology, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. Wilfried.Budach@med.uni-duesseldorf.de.
authors.forename: Wilfried
authors.initials: W
authors.lastname: Budach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001847:Bone Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D010014:Osteolysis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D010146:Pain / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D010166:Palliative Care; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate