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Radiotherapy in the management of solitary extramedullary plasmacytoma.
Intern Med J. 2005 Apr; 35(4):211-5.IM

Abstract

BACKGROUND

Solitary extramedullary plasmacytoma (SEP) is a rare tumour for which the standard treatment remains local radiotherapy (RT). We present a study of a multi-institutional experience, between 1980 and 1999, in an attempt to better understand the natural history of SEP and to identify possible prognostic factors.

METHODS

The records at Radiation Oncology Victoria and Peter MacCallum Cancer Centre, Melbourne, were used for the identification of patients. The inclusion criteria were as follows: (i) histological confirmation of clonal plasma cells involving a single extramedullary site with or without lymph node involvement; (ii) no histological evidence of bone marrow involvement; (iii) no evidence of distant bone lesion on radiographic skeletal survey (bone erosions adjacent to the primary thought to be due to contiguous involvement were permitted) and (iv) no anaemia, hypercalcaemia or renal impairment due to plasma cell dyscrasia.

RESULTS

A total of 16 patients was identified, with a median follow up of 66 months (range 12-211 months). The head and neck region accounted for the majority of presentations (88%). Among all patients, a serum mono-clonal paraprotein was found in three patients and bone erosion was identified in seven patients. All patients received local RT, although two patients also received elective nodal irradiation (ENI). The median RT dose was 45 Gy (range 40-50.4 Gy). Local control was achieved in all patients (100%), however, regional recurrence outside the RT fields occurred in 2/16. Multiple myeloma (MM) developed in five patients, all within 5 years. The predicted 10-year myeloma free survival is 75% and 10-year overall survival is 54%.

CONCLUSION

RT can achieve excellent local control of SEP. The rate of conversion to MM is 31%. Moderate dose RT of at least 40 Gy using limited radiation fields is recommended, although ENI should be considered if toxicity is not increased.

Authors+Show Affiliations

Radiation Oncology Victoria, Royal Melbourne Hospital, Melbourne, Victoria 3002, Australia. mchao@radoncvic.com.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

15836498

Citation

Chao, M W., et al. "Radiotherapy in the Management of Solitary Extramedullary Plasmacytoma." Internal Medicine Journal, vol. 35, no. 4, 2005, pp. 211-5.
Chao MW, Gibbs P, Wirth A, et al. Radiotherapy in the management of solitary extramedullary plasmacytoma. Intern Med J. 2005;35(4):211-5.
Chao, M. W., Gibbs, P., Wirth, A., Quong, G., Guiney, M. J., & Liew, K. H. (2005). Radiotherapy in the management of solitary extramedullary plasmacytoma. Internal Medicine Journal, 35(4), 211-5.
Chao MW, et al. Radiotherapy in the Management of Solitary Extramedullary Plasmacytoma. Intern Med J. 2005;35(4):211-5. PubMed PMID: 15836498.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Radiotherapy in the management of solitary extramedullary plasmacytoma. AU - Chao,M W, AU - Gibbs,P, AU - Wirth,A, AU - Quong,G, AU - Guiney,M J, AU - Liew,K H, PY - 2005/4/20/pubmed PY - 2005/8/5/medline PY - 2005/4/20/entrez SP - 211 EP - 5 JF - Internal medicine journal JO - Intern Med J VL - 35 IS - 4 N2 - BACKGROUND: Solitary extramedullary plasmacytoma (SEP) is a rare tumour for which the standard treatment remains local radiotherapy (RT). We present a study of a multi-institutional experience, between 1980 and 1999, in an attempt to better understand the natural history of SEP and to identify possible prognostic factors. METHODS: The records at Radiation Oncology Victoria and Peter MacCallum Cancer Centre, Melbourne, were used for the identification of patients. The inclusion criteria were as follows: (i) histological confirmation of clonal plasma cells involving a single extramedullary site with or without lymph node involvement; (ii) no histological evidence of bone marrow involvement; (iii) no evidence of distant bone lesion on radiographic skeletal survey (bone erosions adjacent to the primary thought to be due to contiguous involvement were permitted) and (iv) no anaemia, hypercalcaemia or renal impairment due to plasma cell dyscrasia. RESULTS: A total of 16 patients was identified, with a median follow up of 66 months (range 12-211 months). The head and neck region accounted for the majority of presentations (88%). Among all patients, a serum mono-clonal paraprotein was found in three patients and bone erosion was identified in seven patients. All patients received local RT, although two patients also received elective nodal irradiation (ENI). The median RT dose was 45 Gy (range 40-50.4 Gy). Local control was achieved in all patients (100%), however, regional recurrence outside the RT fields occurred in 2/16. Multiple myeloma (MM) developed in five patients, all within 5 years. The predicted 10-year myeloma free survival is 75% and 10-year overall survival is 54%. CONCLUSION: RT can achieve excellent local control of SEP. The rate of conversion to MM is 31%. Moderate dose RT of at least 40 Gy using limited radiation fields is recommended, although ENI should be considered if toxicity is not increased. SN - 1444-0903 UR - https://www.unboundmedicine.com/medline/citation/15836498/Radiotherapy_in_the_management_of_solitary_extramedullary_plasmacytoma_ L2 - https://doi.org/10.1111/j.1445-5994.2005.00804.x DB - PRIME DP - Unbound Medicine ER -