Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL.
Am J Clin Oncol. 2020 Oct;43(10):709-713. doi: 10.1097/COC.0000000000000734.
Definitive radiotherapy (RT) with or without surgery is the standard of care for solitary plasmacytoma. Here, we report clinical outcomes for this rare malignant neoplasm.
We retrospectively reviewed the medical records of adults with solitary plasmacytoma treated with definitive RT between 1963 and 2015 at a single institution, and assessed disease control, survival, and toxicity per Common Terminology Criteria for Adverse Events (CTCAE), version 4.
A total of 42 patients with solitary plasmacytoma of the bone (SPB, n=27) or extramedullary plasmacytoma (EMP, n=15) were treated with definitive RT with (n=11) or without (n=31) surgical resection. The median age at diagnosis was 59 years (range: 28 to 76 y).Twenty-two patients had tumors ≥5 cm and 20 had tumors <5 cm. Immunoglobulins were elevated in 23 patients and M-protein in 14. The median RT dose was 45 Gy (range: 15 to 54 Gy) over a median 25 fractions (range: 1 to 38 fractions) with 3 patients receiving twice-daily fractionation and 6 received elective nodal irradiation. No patients received adjuvant chemotherapy. The median follow-up was 10.3 years. The 10-year local control rate after RT was 88%. Five patients who developed a local recurrence had SPB ≥5 cm. The 10-year multiple myeloma-free survival rates were: overall, 47%; SPB, 24%; and EMP, 87% (P=0.0012). The 10-year cause-specific survival rate was 75%: 64% for SPB versus 93% for EMP (P=0.0116). The 10-year overall survival rate was 60%. Three patients experienced late grade 2+ toxicity.
Definitive RT with moderate doses results in excellent local control. We observed a higher rate of progression to multiple myeloma and lower survival in patients with SPB compared with EMP.
有或无手术的确定性放疗（RT）是孤立性浆细胞瘤的标准治疗方法。在此，我们报告这种罕见恶性肿瘤的临床结果。
我们回顾性分析了 1963 年至 2015 年在一家机构接受确定性 RT 治疗的成人孤立性浆细胞瘤患者的病历，并根据常见不良事件术语标准（CTCAE）第 4 版评估疾病控制、生存和毒性。
共 42 例骨孤立性浆细胞瘤（SPB，n=27）或髓外浆细胞瘤（EMP，n=15）患者接受确定性 RT 治疗，其中 11 例患者接受手术切除，31 例患者未接受手术切除。诊断时的中位年龄为 59 岁（范围：28 至 76 岁）。22 例患者肿瘤≥5cm，20 例患者肿瘤＜5cm。23 例患者免疫球蛋白升高，14 例患者 M 蛋白升高。中位 RT 剂量为 45Gy（范围：15 至 54Gy），中位分割 25 次（范围：1 至 38 次），3 例患者接受每日 2 次分割，6 例患者接受选择性淋巴结照射。没有患者接受辅助化疗。中位随访时间为 10.3 年。RT 后 10 年局部控制率为 88%。5 例局部复发患者 SPB≥5cm。10 年无多发性骨髓瘤生存率为：总体为 47%；SPB 为 24%；EMP 为 87%（P=0.0012）。10 年无病生存率为 75%：SPB 为 64%，EMP 为 93%（P=0.0116）。10 年总生存率为 60%。3 例患者发生晚期 2+级毒性。
中等剂量的确定性 RT 可获得优异的局部控制效果。我们观察到 SPB 患者比 EMP 患者多发性骨髓瘤进展率更高，生存率更低。
