Background
Retrospective single-institution study (Düsseldorf) evaluating pain response and recalcification after RT for bone lesions in multiple myeloma. 153 patients, 295 irradiated lesions. RT doses ranged 8–50 Gy (median 25 Gy in 2.5 Gy/fraction). Assessed pain response (NRS scale) and radiographic recalcification.
Interventions and follow up
Arm A: Higher-dose RT (≥30 Gy)
Arm B: Lower-dose RT (<30 Gy); retrospective comparison within cohort
Primary endpoint: Pain response (complete + partial); recalcification rate
mFollow up: Not specified (retrospective)
Arm B: Lower-dose RT (<30 Gy); retrospective comparison within cohort
Primary endpoint: Pain response (complete + partial); recalcification rate
mFollow up: Not specified (retrospective)
Results
Pain Response (overall): Complete 31%, partial 54%; total response 85%
Higher RT dose vs. lower: Better pain relief (P=.023) and recalcification (P=.048)
Recalcification: 48% of irradiated lesions showed radiographic recalcification
Older age: Associated with better pain response (P=.031)
Higher RT dose vs. lower: Better pain relief (P=.023) and recalcification (P=.048)
Recalcification: 48% of irradiated lesions showed radiographic recalcification
Older age: Associated with better pain response (P=.031)
Adverse events
Main adverse events: Not systematically reported in this retrospective series. Short-term fatigue and localized skin reactions consistent with RT field size and dose. No grade 4 or treatment-related deaths reported.
Conclusions
RT is highly effective for pain control in MM bone lesions, achieving an 85% overall response rate. Higher RT doses (>30 Gy) are associated with improved pain relief and recalcification, supporting use of more intensive fractionation when local disease control is desired.
Key Limitations
Key Limitations: Retrospective, single-institution; heterogeneous RT doses and fractionation schedules; no standardized pain assessment tool used prospectively; selection bias likely (sicker patients may have received shorter courses). No OS or progression-to-MM data.
Clinical Context
Supports dose escalation beyond palliative single-fraction 8 Gy for MM bone lesions where recalcification or durable local control is desired. Consistent with ILROG guideline recommendations for 20–30 Gy in higher-risk lesions (impending fracture, weight-bearing bone).
References