Brief Article
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World J Radiol. Apr 28, 2013; 5(4): 173-177
Published online Apr 28, 2013. doi: 10.4329/wjr.v5.i4.173
Volumetric modulated arc radiotherapy for limited osteosclerotic myeloma
Aurélie Robles, Antonin Levy, Coralie Moncharmont, Lamine Farid, Jean-Baptiste Guy, Nadia Malkoun, Lysian Cartier, Cyrus Chargari, Isabelle Guichard, Jean-Noël Talabard, Guy de Laroche, Nicolas Magné
Aurélie Robles, Coralie Moncharmont, Lamine Farid, Jean-Baptiste Guy, Nadia Malkoun, Lysian Cartier, Jean-Noël Talabard, Guy de Laroche, Nicolas Magné, Department of Radiotherapy, Institut de Cancérologie de la Loire, 42270 St Priest en Jarez, France
Antonin Levy, Department of Radiation Oncology, Institut Gustave Roussy, Université Paris XI, 94800 Villejuif, France
Cyrus Chargari, Department of Radiation Oncology, Hôpital d’Instruction des Armées du Val-de-Grâce, 75005 Paris, France
Isabelle Guichard, Department of Internal Medicine, CHU Saint Etienne, 42000 Saint Etienne, France
Author contributions: Robles A provided data and wrote the paper; Magné N and Levy A designed the study, analyzed data, and wrote the paper; Moncharmont C, Farid L, Guy JB, Malkoun N, Cartier L, Chargari C, Guichard I, Talabard JN and de Laroche G reviewed the paper.
Correspondence to: Nicolas Magné, MD, PhD, Department of Radiotherapy, Institut de Cancérologie de la Loire, 108 bis, Avenue Albert Raimond, BP 60008, 42271 St Priest en Jarez cedex, France. nicolas.magne@icloire.fr
Telephone: +33-4-77917434 Fax: +33-4-77917197
Received: October 18, 2012
Revised: December 14, 2012
Accepted: February 5, 2013
Published online: April 28, 2013
Processing time: 200 Days and 22.6 Hours
Abstract

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 effects.

RESULTS: 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.

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