Bolek T W, Marcus R B, Mendenhall N P
Department of Radiation Oncology, University of Florida, College of Medicine, Gainesville, USA.
Int J Radiat Oncol Biol Phys. 1996 Sep 1;36(2):329-33. doi: 10.1016/s0360-3016(96)00334-3.
This retrospective review evaluates the results of radiotherapy used for curative intent in the management of solitary plasmacytoma.
Between August 1963 and January 1993, 37 patients with a solitary plasmacytoma were treated with curative intent at the University of Florida. Criteria for inclusion in the study were (a) a biopsy-proven plasmacytoma, (b) no tumor in the bone marrow on biopsy, and (c) no evidence of disseminated disease on skeletal survey. The primary site was osseous in 27 patients and extramedullary in 10 patients; 9 of the 10 extramedullary lesions were located in the upper respiratory passages. Treatment consisted of primary radiotherapy in all but one patient, who received surgical resection alone. Two patients also received adjuvant chemotherapy. The median radiation dose was 43.2 Gy in 1.8-Gy fractions. Absolute survival, progression to myeloma, and local control rates were calculated using the Kaplan-Meier method. A multivariate analysis was performed for prognostic factors predictive of absolute survival.
Multivariate analysis revealed tumor type (osseous vs. extramedullary) to be predictive of absolute survival (p = 0.12). Factors not predictive of survival were age, sex, use of chemotherapy, immunoglobulin level, and type of immunoglobulin elevated. Patients with osseous tumors had a lower survival rate than those with extramedullary tumors (55% vs. 80% at 10 years, p = 0.06). Multiple myeloma was more likely to develop in patients with osseous tumors (54% vs. 11% at 10 years, 100% vs. 33% at 15 years, p = 0.03). Of patients in whom multiple myeloma developed, those with osseous tumors had a poorer survival rate after development of myeloma (32% vs. 100% at 5 years, p = 0.11). Local relapse developed in 1 patient with an osseous tumor 10 months after treatment with 28.3 Gy in 14 fractions; this was controlled with an additional 28.3 Gy in 10 fractions. Local failure did not develop in any patient with an extramedullary tumor.
Radiotherapy is an effective local treatment for solitary plasmacytoma. Osseous tumors were found to have a poor prognosis compared with extramedullary tumors.
本回顾性研究评估了以治愈为目的的放射治疗在孤立性浆细胞瘤治疗中的效果。
1963年8月至1993年1月期间，佛罗里达大学对37例孤立性浆细胞瘤患者进行了以治愈为目的的治疗。纳入本研究的标准为：(a) 经活检证实为浆细胞瘤；(b) 骨髓活检未发现肿瘤；(c) 骨骼检查未发现播散性疾病证据。27例患者的原发部位在骨骼，10例患者在髓外；10例髓外病变中有9例位于上呼吸道。除1例仅接受手术切除的患者外，所有患者均接受了原发灶放射治疗。2例患者还接受了辅助化疗。中位放射剂量为43.2 Gy，分1.8 Gy每次给予。采用Kaplan-Meier法计算总生存率、进展为骨髓瘤的发生率和局部控制率。对预测总生存的预后因素进行了多因素分析。
多因素分析显示肿瘤类型（骨骼型与髓外型）可预测总生存（p = 0.12）。不能预测生存的因素包括年龄、性别、化疗的使用、免疫球蛋白水平以及升高的免疫球蛋白类型。骨骼肿瘤患者的生存率低于髓外肿瘤患者（10年时分别为55%和80%，p = 0.06）。骨骼肿瘤患者更易发生多发性骨髓瘤（10年时分别为54%和11%，15年时分别为100%和33%，p = 0.03）。在发生多发性骨髓瘤的患者中，骨骼肿瘤患者在骨髓瘤发生后的生存率更低（5年时分别为32%和100%，p = 0.11）。1例骨骼肿瘤患者在接受28.3 Gy分14次治疗10个月后局部复发；追加28.3 Gy分10次治疗后得到控制。髓外肿瘤患者均未发生局部失败。
放射治疗是孤立性浆细胞瘤有效的局部治疗方法。与髓外肿瘤相比，骨骼肿瘤的预后较差。
