How would you approach the treatment of a single vertebral body involved with multiple myeloma (MM)?

What dose/fractionation scheme and treatment volumes are most appropriate?

Could you consider treating a single vertebral level with SBRT if dose constraints are met?

Answer from: Radiation Oncologist at Academic Institution

If single level of involvement and no other bony disease (i.e. plasmacytoma of the spine), I would favor standard fractionation to 45-50 Gy as definitive treatment. I usually treat 50 Gy/25 fractions. If myeloma with other areas of disease, I favor standard palliative RT and cover 1 vertebral body ...

Comments

Radiation Oncologist at Varian Medical Systems/Allegheny health network
For bony plasmacytoma, based on Canadian data and ...

Radiation Oncologist at GenesisCare USA
ILROG reference: Tsang et al., PMID 29976492.

Answer from: Radiation Oncologist at Academic Institution

Multiple myeloma (MM) of the spine can be treated in the same way as described in the NRG/RTOG 0631. In a small series of MM with or without spinal cord compression, the median dose was 16 Gy (10-18 Gy) to the painful regions of the spine. The result was >80% pain control of the treated spine and...

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