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Editorials
sity-modulated radiotherapy or volume-modulated arc therapy such dose distributions can be routinely attained (Figure. 1). Considering possibilities of modern imaging, including magnetic resonance imaging and positron emis- sion tomography/computed tomography, which are able to depict myeloma lesions very precisely, highly confor- mal radiotherapy techniques can be applied with a com- paratively low risk of missing the target.5 Thus, even high- precision stereotactic radiotherapy or radiosurgery can be considered for the treatment of critical multiple myeloma lesions in the spine.6 Of course, using such radiation tech- niques, effective systemic therapy is an essential part of the interdisciplinary treatment concept.
Radiotherapy is the treatment of choice for multiple myeloma in two situations: as curative treatment for sin- gle plasmacytoma lesions and as palliation for local symp- toms due to certain bone or extramedullary lesions. In both situations local tumor control is most important and, therefore, the radiation dose sought should not differ. In fact, the decision regarding each patient’s or each lesion’s dose should also be taken on the basis of that patient’s general condition and life expectancy. In this context, spe- cific help for dose decisions can be obtained by scores, such as the one developed by Rades et al.7
Furthermore, and probably most importantly, consid- ering multiple myeloma and also solitary plasmacytoma as a systemic disease, radiation doses and volumes should not adversely affect the administration of essen- tial systemic therapies by being toxic to the bone mar-
row. To ensure this, patients diagnosed with multiple myeloma should be treated in an interdisciplinary man- ner by oncologists and radiation oncologists together. In summary, the work by Elhammali et al. may not cause a paradigm shift, but it does contribute important data with regards to a concept of individualized radiation therapy.
References
1. Soekojo CY, Kumar SK. Stem-cell transplantation in multiple myelo- ma: how far have we come? Ther Adv Hematol. 2019;10: 2040620719888111.
2. Piechotta V, Jakob T, Langer P, et al. Multiple drug combinations of bortezomib, lenalidomide, and thalidomide for first-line treatment in adults with transplant-ineligible multiple myeloma: a network meta-analysis. Cochrane Database Syst Rev. 2019;2019(11).
3. Tsang RW, Campbell BA, Goda JS, et al. Radiation therapy for soli- tary plasmacytoma and multiple myeloma: guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys. 2018;101(4):794-808.
4. Elhammali A, Amini B, Ludmir EB, et al. New paradigm for radiation in multiple myeloma: lower yet effective dose to avoid radiation tox- icity. Haematologica. 2020;105(7):e355-e357.
5. Zhu Q, Zou X, You R, et al. Establishment of an innovative staging system for extramedullary plasmacytoma. BMC Cancer. 2016; 16(1):777.
6. Miller JA, Balagamwala EH, Chao ST, et al. Spine stereotactic radio- surgery for the treatment of multiple myeloma. J Neurosurg Spine. 2017;26(3):282-290.
7. Rades D, Conde-Moreno AJ, Cacicedo J, et al. A predictive tool par- ticularly designed for elderly myeloma patients presenting with spinal cord compression. BMC Cancer. 2016;16:292.
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