Multiple Myeloma Muscle Infiltration with Atypical Presentation: Lower Extremity Treatment with Three Arc VMAT Radiotherapy Plans

Öz

Multiple Myeloma Muscle Infiltration with Atypical Presentation: Lower Extremity Treatment with Three Arc VMAT Radiotherapy Plans

Abstract

Extramedullary myeloma can occur in a variety of organs; however, muscle involvement is rarely reported. We present a case of multiple myeloma patient who progressed with extramedullary lower extremity muscle involvement while receiving chemotherapy. Pathologic plasmacytoma was confirmed by involvement biopsy. Palliative radiotherapy was planned for the patient who complained of severe pain, weakness and edema in the leg. Due to the very large radiotherapy field, a special three-arc VMAT plan was made for the patient.

Keywords

• Multiple myeloma muscle infiltration
• radiotherapy
• volumetric modulated arc therapy

Kaynakça

1. 1. Bird SA, Boyd K. Multiple myeloma: an overview of management. Palliative care and social practice. 2019;13:1-13.
2. 2. Eslick R, Talaulikar D. Multiple myeloma: from diagnosis to treatment. Australian family physician. 2013;42(10):684-8.
3. 3. Miceli TS, Colson K, Faiman BM, Miller K, Tariman JD, Board IMFNL. Maintaining bone health in patients with multiple myeloma: Survivorship care plan of the International Myeloma Foundation Nurse Leadership Board. Clinical Journal of Oncology Nursing. 2011;15:9-23.
4. 4. Society AC. Signs and Symptoms of Multiple Myeloma [Internet]; 2018. Podcast. Available from: https://www.cancer.org/content/dam/CRC/PDF/Public/8740.00.pdf
5. 5. Marshall C, Frantz N, Kikano E, Smith DA, Guler E, Tirumani SH, et al. The Role of Imaging and Systemic Treatments in Myeloma: A Primer for Radiologists. AJR American journal of roentgenology. 2020;214(6):1321-34.
6. 6. Reisenbuckler C. Multiple myeloma and diagnostic imaging. Radiologic Technology. 2014;85(4):391-410.
7. 7. Zeiser R, Deschler B, Bertz H, Finke J, Engelhardt M. Extramedullary vs medullary relapse after autologous or allogeneic hematopoietic stem cell transplantation (HSCT) in multiple myeloma (MM) and its correlation to clinical outcome. Bone marrow transplantation. 2004;34(12):1057-65.
8. 8. Fagkrezos D, Manes K, Paraskeva K, Lenos M, Triantopoulou C, Apessou D, et al. Secondary extramedullary plasmacytoma of sigmoid colon in a patient with multiple myeloma: a case report. Journal of Medical Case Reports. 2018;12:1-7.

9. 9. Yu S, Wang Y, He P, Shao B, Liu F, Xiang Z, et al. Effective Combinations of Immunotherapy and Radiotherapy for Cancer Treatment. Frontiers in oncology. 2022;12:1-18.
10. 10. Matuschek C, Ochtrop TA, Bölke E, Ganswindt U, Fenk R, Gripp S, et al. Effects of Radiotherapy in the treatment of multiple myeloma: a retrospective analysis of a Single Institution. Radiation oncology (London, England). 2015;10:1-9.
11. 11. Hussein MA, Juturi JV, Lieberman I. Multiple myeloma: present and future. Current opinion in oncology. 2002;14(1):31-5.
12. 12. Chen B, Cai L, Zhou F. Management of acute spinal cord compression in multiple myeloma. Critical Reviews in Oncology Hematology. 2021;160 (2021):1-7.
13. 13. Talamo G, Dimaio C, Abbi KK, Pandey MK, Malysz J, Creer MH, et al. Current role of radiation therapy for multiple myeloma. Frontiers in oncology. 2015;5(40):1-6.
14. 14. Painter SL, Dickens E, Elston JS. Isolated extraocular muscle infiltration with plasmacytoma treated with localized injection of dexamethasone. Journal of Neuro-Ophthalmology. 2015;35(2):168-70.
15. 15. Ak MA, Erdemir RU. Multiple muscle involvement in relapsed multiple myeloma: A rare case. Journal of Cancer Research and Therapeutics. 2022;18(4):1165-7.
16. 16. Michels TC, Petersen KE. Multiple myeloma: diagnosis and treatment. American family physician. 2017;95(6):373-83.
17. 17. Palumbo A, Rajkumar SV. Multiple myeloma: chemotherapy or transplantation in the era of new drugs. European journal of haematology. 2010;84(5):379-90.
18. 18. Albano D, Benenati M, Bruno A, Bruno F, Calandri M, Caruso D, et al. Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe. Insights into Imaging. 2021;12(1):1-28.
19. 19. Nijhof IS, van de Donk NW, Zweegman S, Lokhorst HM. Current and new therapeutic strategies for relapsed and refractory multiple myeloma: an update. Drugs. 2018;78:19-37.
20. 20. Jakobczyk H, Sciortino F, Chevance S, Gauffre F, Troadec M-B. Promises and limitations of nanoparticles in the era of cell therapy: Example with CD19-targeting chimeric antigen receptor (CAR)-modified T cells. International Journal of Pharmaceutics. 2017;532(2):813-24.
21. 21. Berenson JR, Matous J, Swift RA, Mapes R, Morrison B, Yeh HS. A phase I/II study of arsenic trioxide/bortezomib/ascorbic acid combination therapy for the treatment of relapsed or refractory multiple myeloma. Clinical Cancer Research. 2007;13(6):1762-8.
22. 22. Kazandjian D, Dew A, Hill E, Ramirez EG, Morrison C, Mena E, et al. Avelumab, a PD‐L1 Inhibitor, in Combination with Hypofractionated Radiotherapy and the Abscopal Effect in Relapsed Refractory Multiple Myeloma. The oncologist. 2021;26(4):288-e541.
23. 23. Gill S, Nowak AK, Bowyer S, Endersby R, Ebert MA, Cook A. Clinical evidence for synergy between immunotherapy and radiotherapy (SITAR). Journal of Medical Imaging and Radiation Oncology. 2022;66(6):881-95.
24. 24. Leigh BR, Kurtts TA, Mack CF, Matzner MB, Shimm DS. Radiation therapy for the palliation of multiple myeloma. International Journal of Radiation Oncology* Biology* Physics. 1993;25(5):801-4.
25. 25. Sanchez I, Oñate D, Hernandez T, Ruiz V, Diaz O, Munoz JS, et al. Solitary Extramedullary Plasmacytoma of the Head and Neck: A Report of Three Cases Treated With Curative Radiotherapy and a Review of the Dose-Control Relationship. Cureus. 2023;15(5): 1-10.
26. 26. Oertel M, Schlusemann T, Shumilov E, Reinartz G, Bremer A, Rehn S, et al. Radiotherapy in Combination with Systemic Therapy for Multiple Myeloma—A Critical Toxicity Evaluation in the Modern Treatment Era. Cancers. 2023;15(11):1-15.
27. 27. Rudzianskiene M, Inciura A, Gerbutavicius R, Rudzianskas V, Macas A, Simoliuniene R, et al. Einzelne Fraktion vs. multiple Fraktionen in der palliativen Strahlentherapie des multiplen Myeloms: Eine prospektive randomisierte Studie. Strahlentherapie und Onkologie. 2017;193:742-9.
28. 28. Tsang RW, Campbell BA, Goda JS, Kelsey CR, Kirova YM, Parikh RR, et al. Radiation therapy for solitary plasmacytoma and multiple myeloma: guidelines from the International Lymphoma Radiation Oncology Group. International Journal of Radiation Oncology* Biology* Physics. 2018;101(4):794-808.