Radiation Oncology, Hôpital d'Instruction des Armées du Val-de-Grâce, Paris, France.
Crit Rev Oncol Hematol. 2012 May;82(2):150-8. doi: 10.1016/j.critrevonc.2011.04.006. Epub 2011 May 28.
Radiation therapy (RT) is the mainstay of treatment of solitary plasmacytoma. In most cases, doses ranging from 40 to 50 Gy yield in a local control more than 80%. However, the prognosis of patients with SP is marked by a high rate of transformation to multiple myeloma (MM), and there is no demonstrated benefit of adjuvant chemotherapy for decreasing this probability. However, clinical benefits could be reached from improving screening for other primary sites of plasmacytoma and earlier discovering signs suggestive of MM. Since such strategy could provide significant information regarding both prognosis and therapy, it has become first importance to improve initial staging of tumor widespread. Although conventional skeletal X-ray survey remains standard, usual sensitivity of radiographies does not permit diagnosing early myeloma lesions and a significant number of patients with supposed SP might be understaged and do not receive the appropriate treatment. The development of more sensitive and specific imaging modalities will make it feasible to earlier detect subclinical lesions, thus leading lead to new approaches in the treatment strategies. Here, we discuss the benefits and limitations of magnetic resonance imaging and positron emission tomography for primary staging of patients with solitary plasmacytoma. Both imaging modalities could also improve target volume delineation and assessment of tumor response after RT.
放射治疗（RT）是治疗孤立性浆细胞瘤的主要方法。在大多数情况下，剂量在 40 到 50Gy 之间，可以使局部控制率超过 80%。然而，SP 患者的预后特点是多发性骨髓瘤（MM）转化率高，辅助化疗并不能降低这种可能性。然而，通过提高对浆细胞瘤其他原发性部位的筛查和更早发现提示 MM 的迹象，可能会获得临床获益。由于这种策略可以提供关于预后和治疗的重要信息，因此改善肿瘤广泛分期的初始评估变得至关重要。尽管常规骨骼 X 线检查仍然是标准方法，但放射线的常规灵敏度不能诊断早期骨髓瘤病变，而且许多被认为是 SP 的患者可能分期不足，没有接受适当的治疗。更敏感和特异的成像方式的发展将使更早地发现亚临床病变成为可能，从而为治疗策略带来新的方法。在这里，我们讨论磁共振成像和正电子发射断层扫描在孤立性浆细胞瘤患者初始分期中的作用和局限性。这两种影像学方法还可以改善放射治疗后靶区的描绘和肿瘤反应的评估。
