Purpose: This study is to define the role of radiation therapy for palliation in the management of multiple myeloma. Method & Materials: Thirty five patients with multiple myeloma received palliative radiotherapy at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, Catholic University Medical College between December 1983 and September 1993. Of the eighty- four treated sites, eighty evaluable sites were analysed retrospectively. The male to female ratio was 1.3:l. Age at diagnosis ranged from 36 to 76 years with a mean of 58 years and the follow-up period ranged from 3 to 134 months with a median of 26 months. The most common treated sites were spine(50%), rib(19%), and pelvis(11%) in decreasing order. The most common symptom was pain(93.7%). Pain was graded as mild, moderate, and severe degree of pain according to clinical classification of pain intensity by WHO. Pain relief following radiation therapy was assessed as complete, partial, or no relief of symptom by analgesic use and change of pain grade. In the case of neurologic impairment, treatment response was assessed by neurologic examination. Results: Total tumor doses ranged from 4 to 35 Gy, with a mean of 19.4 Gy. Symptom relief waa obtained in 76(95%) of 80 evaluable symptomatic sites. No clear dose-response relationship could be demonstrated in this study(p>0.05). The likelihood of symptom relief was not influenced by the location of the lesion, use of concurrent chemotherapy, serum hemoglobin level, serum calcium level, or initial pain grade(p>0.05). Of the 76 responding sites, 9 sites(11.8%) relapsed after median symptam-free interval of 22 months(range, 2-75 months). Neither the probability of relapse nor the time to relapse was related to the radiation dose(p>0.05). Retreatment of relapsing sites provided effective palliation in all cases. Conclusion: Low dose local external radiation therapy provides effective palliation in the management of multiple myeloma.
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