Question:My wife has multiple myeloma that has spread to the bone. Her neck is affected the most. The doctor has advised radiation to the spine. What would happen if we don't do this?
Answer:When cancer spreads to the cervical spine (neck), it starts to destroy the bone. The process of bone destruction is called osteolysis. If enough of the bone is affected, fracture can occur. The bones may start to collapse. The result of either of these events can be pain, instability, and deformity.
Treatment may depend on the patient's prognosis. Treatment is advised if the patient is expected to recover or possibly live longer by having treatment. Sometimes quality of life is improved enough that the treatment (with its possible side effects) is still more beneficial than not having treatment.
Radiation has been shown to help stop the destruction of bone in the cervical spine from multiple myeloma metastases. In fact, there are case reports of reversal of the bone destruction. X-rays show fractures heal and bone remodeling can occur with radiation alone.
In some cases, surgery may be needed to stabilize the spine. Spinal fusion may be needed. But since radiation alone has been so effective, this is the first step. The next step (if any is needed) is based on the patient's response to the treatment and results at the bony level as seen on X-ray.Ganesh Rao, MD, et al. Multiple Myeloma of the Cervical Spine: Treatment Strategies for Pain and Spinal Instability. In Journal of Neurosurgery: Spine. August 2006. Vol. 5. No. 2. Pp. 140-145.
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