Utilization of radiation therapy in multiple myeloma: trends and changes in practice

Sikander Ailawadhi, Ryan Frank, Meghna Ailawadhi, Zahara Kanji, Prachi Jani, Mark Fiala, Mays Abdulazeez, Salman Ahmed, Chander Shekher Aggarwal, Sonikpreet Aulakh, David Hodge, Vivek Roy, Victoria R. Alegria, Aneel Paulus, Asher Chanan-Khan, Taimur Sher

Research output: Contribution to journalArticlepeer-review

Abstract

Plasma cell disorders including plasmacytomas and multiple myeloma (MM) are exquisitely radiosensitive, and thus, radiation therapy (XRT) is used effectively in their management. The role of XRT in the setting of novel MM therapeutics has not been explored. The 2016 National Cancer Database (NCDB) for MM with patients diagnosed between 2004 and 2013 was studied. Association between utilization of XRT as part of initial therapy and patient, disease, or treating facility characteristics was studied. A total of 111,281 cases with 91.6% MM, 7% osseous plasmacytoma (PLA-O), and 1.4% extramedullary plasmacytoma (PLA-E) were identified. XRT was utilized as part of initial therapy in 25.4% cases, including 69.3% of PLA-O, 60% of PLA-E, and 21.5% of MM patients. Patients with PLA-E and MM were significantly less likely to receive XRT as compared to PLA-O (p < 0.001). A significantly decreased use of XRT was noted over time (p < 0.001), and for advancing patient age (p < 0.001), women (p < 0.001), and blacks (p < 0.001), and with increasing income (p = 0.015). Patients with Medicare were less likely to receive XRT (OR 0.86, 95% CI 0.78, 0.94) as compared to uninsured as were those with initial treatment at academic or high-volume facilities and facilities performing stem cell transplant. There was overall decreased utilization of XRT in recent years, possibly due to advent of efficacious systemic agents for MM therapy, with a higher XRT utilization for plasmacytomas. Patterns of XRT use need to be explored prospectively, so that uniform standards of healthcare delivery can be maintained and treatment heterogeneity can be minimized.

Original languageEnglish (US)
Pages (from-to)735-741
Number of pages7
JournalAnnals of hematology
Volume100
Issue number3
DOIs
StatePublished - Mar 2021

Keywords

  • Multiple myeloma
  • NCDB
  • Plasmacytoma
  • Radiation therapy

ASJC Scopus subject areas

  • Hematology

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