A number of patients may benefit from radiation therapy. Radiation therapy can provide rapid local control of MM or plasmacytoma that is causing pain or acute organ compromise such as spinal cord compression.

In patients with solitary bone plasmacytoma or solitary extramedullary plasmacytoma, radiotherapy alone can offer durable control, and potentially cure.

Timeframe for starting treatment

• For acute critical organ compromise, such as symptomatic spinal cord compression, patients should start radiotherapy within 24 hours of referral where possible, with a maximum acceptable waiting time within 48 hours.
• For symptomatic tumours causing pain, radiotherapy should begin within 48 hours of referral where possible, with a maximum acceptable waiting time of 14 days.
• For solitary bone plasmacytoma or extramedullary plasmacytoma where the treatment goal is curative, radiotherapy should begin within 14 days of referral where possible, with a maximum acceptable waiting time of 28 days.
• These timeframes concur with the Royal Australian and New Zealand College of Radiologists guidelines (RANZCR 2013).

Training and experience required of the appropriate specialists

Fellow of the Royal Australian and New Zealand College of Radiologists or equivalent, with adequate training and experience, institutional credentialing and agreed scope of practice in MM.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation therapy, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiotherapy (IGRT)
• dedicated CT planning
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management