Radiotherapy in the treatment of solitary plasmacytoma.

Abstract

Solitary plasmacytoma of bone (SPB) and extramedullary plasmacytoma (EMP) are rare. High local control rates are reported with radiotherapy, although the optimal dose and extent of radiotherapy portals remains controversial. Between 1983 and 1993, 30 patients with solitary plasmacytoma were seen at the Regional Cancer Centre, Trivandrum, India. 23 patients had SPB and seven EMP. The mean age was 52 years and the male to female ratio 3.2:1. Diagnosis of SPB was confirmed by biopsy in 16 patients and tumour excision in seven. 20 patients received megavoltage radiotherapy to the bone lesion with limited margins, and one received chemotherapy. Two patients who underwent complete tumour excision received no further treatment. All seven patients with EMP received megavoltage radiotherapy, four following biopsy and three after tumour excision. Local control was achieved in all patients with SPB. Nine progressed to multiple myeloma and one developed a solitary plasmacytoma in another bone. Six patients with EMP achieved local control. Three later progressed to multiple myeloma and one had local relapse. Median time to relapse was 28 months in SPB and 30 months in EMP. 5-year overall survival rates were 82% and 57% for patients with SPB and EMP, respectively. The corresponding progression free survival rates were 55% and 50%, respectively. Age, sex, site of tumour, serum M protein and haemoglobin levels did not significantly influence progression free survival. The extent of surgery, radiotherapy dose or time to relapse were not significant prognostic factors. Radiotherapy appears to be an effective modality of treatment of solitary plasmacytoma. No dose-response relationship is observed, and high local control rates are achieved with limited portals. Progression to multiple myeloma is the commonest pattern of failure, although no prognostic factors for progression are identified. The role of chemotherapy in preventing disease progression needs further evaluation.

Radiotherapy of solitary plasmacytoma

“…Data published so far are inconsistent: Significantly different OS rates were found by Ozsahin et al, who described 10-year overall survival rates of 72% for EP and 52% for SBP (p=0.04) [4], and Tsang et al, who reported 8-year overall survival rates of 70% or 33%, respectively (p=0.023). In contrast, neither Bolek et al [12] nor Jyothirmay et al [13] could detect a significant difference in OS.…”

A Case of Multiple Myeloma: Mimicking Carcinoma Larynx

“…The overall 10 year survival rate ranges from 45 to 100 %, the difference is in accordance with the rate of conversion to Multiple myeloma [7,[11][12][13][14].…”

Sonographic Diagnosis of a Tracheal Extramedullary Plasmacytoma

“…Hemoptysis, always scanty and episodic, is rather common and more disturbing for clinicians. 3,7,11,12 Reyhan et al The mass lesion has the same density as the thyroid tissue and has marked homogeneous enhancement after intravenous contrast agent administration (arrow). B, On virtual bronchoscopic images, the tracheal lumen is markedly narrowed by the mass.…”