Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):794-808. doi: 10.1016/j.ijrobp.2018.05.009. Epub 2018 Jun 20.
To develop guidelines for the work-up and radiation therapy (RT) management of patients with plasma cell neoplasms.
A literature review was conducted covering staging, work-up, and RT management of plasma cell neoplasms. Guidelines were developed through consensus by an international panel of radiation oncologists with expertise in these diseases, from the International Lymphoma Radiation Oncology Group. RT volume definitions are based on the International Commission on Radiation Units and Measurements.
Plasma cell neoplasms account for approximately one-fifth of mature B-cell neoplasms in the United States. The majority (∼95%) are diagnosed as multiple myeloma, in which there has been tremendous progress in systemic therapy approaches with novel drugs over the last 2 decades, resulting in improvements in disease control and survival. In contrast, a small proportion of patients with plasma cell neoplasms present with a localized plasmacytoma in the bone, or in extramedullary (extraosseous) soft tissues, and definitive RT is the standard treatment. RT provides long-term local control in the solitary bone plasmacytomas and is potentially curative in the extramedullary cases. This guideline reviews the diagnostic work-up, principles, and indications for RT, target volume definition, treatment planning, and follow-up procedures for solitary plasmacytoma. Specifically, detailed recommendations for RT volumes and dose/fractionation are provided, illustrated with specific case scenarios. The role of palliative RT in multiple myeloma is also discussed.
The International Lymphoma Radiation Oncology Group presents a standardized approach to the use and implementation of definitive RT in solitary plasmacytomas. The modern principles outlining the supportive role of palliative RT in multiple myeloma in an era of novel systemic therapies are also discussed.
制定浆细胞肿瘤患者的检查和放射治疗（RT）管理指南。
对浆细胞肿瘤的分期、检查和 RT 管理进行了文献回顾。指南由国际放射肿瘤学家小组通过共识制定，该小组专家专长于这些疾病，来自国际淋巴瘤放射肿瘤学组。RT 体积定义基于国际辐射单位和测量委员会。
浆细胞肿瘤在美国成熟 B 细胞肿瘤中约占五分之一。大多数（约 95%）被诊断为多发性骨髓瘤，在过去 20 年中，新型药物的系统治疗方法取得了巨大进展，导致疾病控制和生存得到改善。相比之下，一小部分浆细胞肿瘤患者表现为局部骨浆细胞瘤或骨髓外（骨外）软组织，明确的 RT 是标准治疗。RT 为孤立性骨浆细胞瘤提供长期局部控制，并且在骨髓外病例中具有潜在的治愈性。本指南回顾了诊断性检查、RT 的原则和适应证、靶区定义、治疗计划和随访程序，用于孤立性浆细胞瘤。特别提供了 RT 体积和剂量/分割的详细建议，并举例说明了具体的病例情况。还讨论了姑息性 RT 在多发性骨髓瘤中的作用。
国际淋巴瘤放射肿瘤学组提出了一种标准化的方法，用于在孤立性浆细胞瘤中使用和实施明确的 RT。还讨论了在新型系统治疗时代姑息性 RT 在多发性骨髓瘤中的支持作用的现代原则。
