Stereotactic radiosurgery for multiple myeloma of the spine
Elibe E, Boyce-Fappiano D, Ryu S, Siddiqui MS, Wen N, Lee I, Rock J, and Siddiqui F. Stereotactic radiosurgery for multiple myeloma of the spine. J Radiat Oncol 2018; 7(1):37-44.
J Radiat Oncol
Objective: The aim of this retrospective analysis is to evaluate the role of stereotactic radiosurgery (SRS) in treating multiple myeloma (MM) of the spine. Methods: Medical records of MM patients who underwent single fraction spine SRS between 6/2001 and 12/2014 at our institution were retrospectively reviewed in this institutional review board-approved analysis. Post-treatment radiographic, neurologic, and pain response were the primary endpoints. Endpoints were evaluated with periodic clinical exams and imaging studies (magnetic resonance imaging and computed tomography). Results: Median SRS dose was 16 Gy (10–18) in a single fraction. Seventy-eight patients (121 treatment sites) were treated. Clinical follow-up was available for 71 patients. Radiographic follow-up was available for 94 treatment sites. Median follow-up was 27.8 months (24 days–12.1 years). Radiographic control was observed in 89.4% of the treated sites. Pain relief occurred in 88.3% of the patients that presented with pain; pain progression occurred in 3.3%. Neurological improvement was observed in 63.6% of the patients that presented with a deficit. In sites where MM approached or compressed the epidural canal or the thecal sac, after SRS, evidence of radiographic regression was observed in 87.1%. Toxicities observed included one patient who experienced a tracheoesophageal fistula 2 years after SRS. After SRS, there were 39 VCFs that were potentially SRS-induced. Conclusion: SRS appears to be effective in the treatment of MM of the spine. To the best of our knowledge, this is the largest such experience reported.