Total-Body Irradiation in Multiple Myeloma

The treatment of multiple myeloma continues to be a perplexing problem for the physician. Even though no absolute cure for the disease has been found, radiotherapy and chemotherapy have been utilized in an attempt to alleviate the pain and suffering associated with the terminal stages. The effects of both modalities are quite similar; but, as a rule, radiation has been employed for local lesions and chemotherapy for disseminated disease. Since neither effectively changes the course of the disease, with the exception of occasional cures after irradiation of a solitary plasmacytoma, therapy is generally aimed at palliation of pain. The life expectancy of multiple myeloma is less than one year following diagnosis for 85 per cent of patients (2), and any treatment which gives temporary relief of pain for several months without undesirable side-effects is gratifying. Local irradiation to painful areas has been proved effective in palliation. Patients with generalized disease and widespread pain, however, have been difficult to manage, and local irradiation is usually ineffective. Chemother apeutic agents, especially urethane, sometimes ameliorate the pain, but frequently produce undesirable side-effects such as gastrointestinal disturbances and leukopenia (1). Total-body exposure to roentgen rays has been employed, with varying degrees of success, by several groups of therapists for treatment of disseminated neoplastic disease (4–8). Their experience prompted the occasional use in recent years of total-body irradiation in 20 patients with multiple myeloma at the North Carolina Memorial Hospital,Chapel Hill, N. C. Method Patients selected for treatment were usually those with widespread disease which responded poorly to local irradiation and/or chemotherapy. A 280 kvp machine was used, with a half-value layer of 1.2 mm Cu, and the target-to-skin distance was 150 cm. With an uncollimated beam, a circular port of slightly greater than one meter in diameter was produced. An output of 13 R per minute in air was measured at 150 cm. The beam was centered at the xiphoid so that the field included all the body above the knees. The splenic region was shielded by a piece of lead rubber of appropriate size. The anterior part of the body was exposed to 150 R/air on the first day, the posterior part on the second day. Some patients had 75 R/air to the anterior and posterior parts of the body over a four-day period. All received a total exposure of 300 R/air (150 R each to the front and the back). Results Twenty patients in all were given total-body irradiation, either alone or in conjunction with local irradiation. None were treated simultaneously with radiation and chemotherapeutic agents, although several had urethane prior to x-ray therapy. The results have been tabulated in Table I. Of 11 patients with total-body irradiation alone, 4 had excellent pain relief for periods from at least two months to one year.