Volumetric modulated arc radiotherapy for limited osteosclerotic myeloma

作     者：Aurélie Robles Antonin Levy Coralie Moncharmont Lamine Farid Jean-Baptiste Guy Nadia Malkoun Lysian Cartier Cyrus Chargari Isabelle Guichard Jean-Noёl Talabard Guy de Laroche Nicolas Magné 

作者机构：Department of Radiotherapy Institut de Cancérologie de la Loire Department of Radiation Oncology Institut Gustave Roussy Université Paris XI Department of Radiation Oncology Hpital d'Instruction des Armées du Val-de-Grace Department of Internal Medicine CHU Saint Etienne 

出 版 物：《World Journal of Radiology》 (世界放射学杂志（英文版）（电子版）)

年 卷 期：2013年第5卷第4期

页      面：173-177页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Volumetric intensity-modulated arc radiotherapy Conformal radiotherapy Critical organs Osteosclerotic myeloma Polyneuropathy organomegaly endocrinopathy monoclonal gammopathy and skin change syndrome 

摘      要：AIM:To assess the feasibility of volumetric intensity-modulated arc radiotherapy (VMAT) in patients with limited polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes syndrome. METHODS:A 70-year-old male with histologically confirmed osteosclerotic myeloma was treated in our department in July 2010 with VMAT. Fourty-six Gray in 23 fractions were given on three bone lesions. Doses delivered to target volume and critical organs were compared with a tridimensional conformal radiotherapy (3D-RT) plan. Treatment was well tolerated without any side ***:VMAT improved dose homogeneity within the target volume, as compared to 3D-RT (standard deviations:2.9 Gy and 1.6 Gy for 3D and VMAT, respectively). VMAT resulted in a better sparing of critical organs. Dose delivered to 20% of organ volume (D20) was reduced from 22 Gy (3D-RT) to 15 Gy (VMAT) for small bowel, from 24 Gy (3D-RT) to 17 Gy (VMAT) for bladder and from 47 Gy (3D-RT) to 3 Gy (VMAT) for spinal cord. Volumes of critical organs that received at least 20 Gy (V20) were decreased by the use of VMAT, as compared to 3D-RT (V20 bladder:10% vs 99%; V20 small bowel:6% vs 21%). One year after treatment completion, no tumor progression has been reported. CONCLUSION:VMAT improved dose distribution as compared to 3D-RT for limited osteosclerotic myeloma, with better saving of critical organs.