What dose do you use to palliate multiple myeloma in a vertebral body?

For ISS Stage 1 MM patients who are going to have an OS of over 10 years, I generally prefer a more protracted regimen of 25 Gy in 10 fractions for improved durability of pain control. I typically only treat the symptomatic VB only and use inverse planning. If there is gross epidural disease or cord...

We generally do 30/10, especially if there is evidence for cord compression or patient underwent surgery. If patient has a poorer prognosis or is about to transfer to hospice in this situation then we'll more strongly consider 20/5 or 8Gy x 1, respectively. There is no wrong answer here (IMO) and it...

For the palliative treatment of bone only disease with no cord compression I use 8 Gy in 1 fraction. It’s interesting that despite multiple trials for bone mets showing single fraction RT is as good as multifraction RT, it is still an underused fractionation scheme. At ASTRO this year, single fracti...

15 Gy in 5 fractions.

20 Gy / 8 fx is an MDACC dose. Some thought of reduced marrow toxicity with lower dosage, plus it is a very responsive histology.