Multiple Myeloma Destroying the Elbow: Long-Lasting Symptom Control and Preservation of Function by Primary Radiotherapy

Context Radiotherapy is the treatment of first choice in bone lesions of plasmacytoma or multiple myeloma (MM). Nevertheless, large bone lesions often completely disrupt the bone structure, jeopardize stability, and thus are considered to enforce stabilization by surgical interventions. In these cases, risks and side effects of invasive measures in elderly, fragile cancer patients or patients in systemic cancer treatment complicate therapy decisions. Therefore, it is of some importance to investigate the results of noninvasive treatment options in such situations. Case description A 54 years-old man presented with an MM lesion of about 30cm in diameter destroying his left distal humerus and elbow joint and causing significant pain. The patient refused surgery as he feared to lose the remaining physiological function of his left hand. Therefore, he received primary radiotherapy with a total dose of 50Gy in 20 fractions. The treatment resolved the pain, revealed excellent results in local tumor control as well as satisfying functional results stable for more than five years so far. Radiotherapy did not constrict necessary systemic therapies. Conclusion MM bone lesions, even with destruction and disintegration of large parts of the bone or joints, can be successfully treated with radiotherapy alone, offering a good chance for excellent, long-lasting local tumor control and satisfying functional results. This opens a promising perspective for therapy decisions avoiding invasive surgical measures in palliative or fragile or elderly cancer patients or patients in need for systemic therapy not allowing longer periods of convalescence after surgical intervention.