Jyothirmayi R, Gangadharan V P, Nair M K, Rajan B
Department of Radiotherapy, Regional Cancer Centre, Trivandrum, India.
Br J Radiol. 1997 May;70(833):511-6. doi: 10.1259/bjr.70.833.9227234.
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.
骨孤立性浆细胞瘤（SPB）和髓外浆细胞瘤（EMP）较为罕见。放疗可实现较高的局部控制率，尽管放疗野的最佳剂量和范围仍存在争议。1983年至1993年期间，印度特里凡得琅地区癌症中心共收治30例孤立性浆细胞瘤患者。其中23例为SPB，7例为EMP。患者平均年龄52岁，男女比例为3.2:1。16例SPB患者经活检确诊，7例经肿瘤切除确诊。20例患者接受了对骨病变边缘有限的兆伏级放疗，1例接受了化疗。2例接受肿瘤完整切除的患者未接受进一步治疗。所有7例EMP患者均接受了兆伏级放疗，4例在活检后进行，3例在肿瘤切除后进行。所有SPB患者均实现了局部控制。9例进展为多发性骨髓瘤，1例在另一处骨骼出现孤立性浆细胞瘤。6例EMP患者实现了局部控制。3例后来进展为多发性骨髓瘤，1例出现局部复发。SPB患者复发的中位时间为28个月，EMP患者为30个月。SPB和EMP患者的5年总生存率分别为82%和57%。相应的无进展生存率分别为55%和50%。年龄、性别、肿瘤部位、血清M蛋白和血红蛋白水平对无进展生存无显著影响。手术范围、放疗剂量或复发时间不是显著的预后因素。放疗似乎是治疗孤立性浆细胞瘤的有效方式。未观察到剂量反应关系，通过有限的放疗野可实现较高的局部控制率。进展为多发性骨髓瘤是最常见的失败模式，尽管未确定进展的预后因素。化疗在预防疾病进展中的作用需要进一步评估。
