Vertebral involvement in multiple myeloma: Clinical profile and role of radiotherapy
Authors: K. P. Haresh, G. K. Rath, R. V. Prabhakar, D. N. Sharma, P. K. Julka
Journal: Journal of Clinical Oncology (2008)

19529 Background: Multiple myeloma (MM) is a progressive hematologic disease characterized by infiltration of bone marrow and bone destruction. The purpose of our study is to evaluate the clinical profile of these patients with spinal involvement and to evaluate the benefits of radiotherapy (RT). Methods: Retrospective study. Patients of MM who received RT for spine between January1992 and August 2000 were enrolled. Hospital records of these patients were thoroughly reviewed. The demographic profile, the sites of involvement, symptoms, signs, the incidence of cord compression, the treatment given, the response to RT and survival were studied. SPSS V.10 software was used for statistical analysis. Results: A total of 111 patients were studied. The median age at presentation was 55 years. The youngest one to have MM in our series is a 29 year old male. The clinical details, treatment and results are shown in the table. The mean duration of symptoms is 7.5 months. On an average it took 45 days for other specialties to refer the patient for RT. Either clinical or radiological evidence of cord compression was seen in 45 patients (40.5%). Patients received on an average 2 cycles of chemotherapy before RT. Even though 55% of the patients received RT on the same day or the next day of attending the RT OPD, the mean time gap between RT registration and RT delivery was 4.5 days. A significant number of patients (53%) had good response to RT. Of the 43 patients who had motor deficits before RT, 46% showed some improvement in power after RT. Patients received on an average 5 Cycles of chemotherapy after RT (median 9 cycles). Bones other than vertebrae was also involved in 80% of the patients. The mean survival in our patient group is 575 days. Conclusions: MM commonly affects the lumbar and lower thoracic spine. Backache the most common symptom may present well in advance. Early diagnosis and prompt delivery of RT will avoid neurologic complications. Excellent palliation can be achieved by local RT. Clinical and treatment characteristics of 111 MM patients with vertebral involvement Characteristic Number (percent) Characteristic Number (percent) Characteristic Number (percent) Characteristic Number (percent) Characteristic Number (percent) AGE <55 years 48 (43.2) PHYSICAL FINDINGS SPINAL SITE INVOLVED RT FRACTIONATION RESPONSE TO RT ≥55 years 63 (56.8) Motor Deficit 43 (38.7) Cervical 1 (0.9) 8Gy/1# 84 (75.7) Good Response 59/111 (53.2) GENDER Male 81 (73) Sensory Deficit 9 (8.1) Upper Dorsal 10 (9) 15Gy/3 # 13 (11.7) Pain improved 42/92 (45.7) Female 30 (27) Autonomic deficit 10 (9) Lower Dorsal 36 (32.4) 20Gy/5# 9 (8.1) Motor power improved 20/43 (46.5) SYMPTOMS OF SPINAL INVOLVEMENT RADIOLOGICAL MODALITY USED Lumbar 40 (36) 30Gy/10# 1 (0.9) Sensory improvement 1/9 (11.1) Backache 92 (83) X-ray 94 (84.7) Mixed 24 (21.6) 45Gy/25# 3 (2.7) OTHER TREATMENT BEFORE RT Limb weakness 38 (34.2) MRI 28 (25.2) NO OF SPINES INVOLVED Others 1 (0.9) Surgery 9 (8.1) Sensory loss 8 (7.2) CT Scan 8 (7.2) Single 43 (38.7) Chemotherapy 41 (36.9) Bowel/bladder disturbance 10 (9) Bone scan 6 (5.4) Multiple 68 (61.3) CHEMOTHERAPY AFTER RT 64 (57.7) No significant financial relationships to disclose.