What RT dose would you use to treat a single site relapse of high risk multiple myeloma?

Depending on the KPS of the patient, it may be 20 Gy in 5 to 36 Gy in 20. Data (Oertel et al., PMID 30987659) support upwards of over 45 Gy, but that is in the de-novo situation. This is post-treatment/transplant and represents a treatment failure and likely palliation. A 2005 paper on this subject notably lacked radiation dose data but several (2 of 11) patients seemed to have been salvaged within the f/u period - most died in a year. Terpos et al., PMID 16191086

Thus, a moderate dose that can help is likely best. The dose is not formally known and clinical judgment must be employed to balance the cost to the patient (time, toxicity, financial) to benefit (pain control, possible salvage).

My starting point would likely be hypofractionated i...