Liebross R H, Ha C S, Cox J D, Weber D, Delasalle K, Alexanian R
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Int J Radiat Oncol Biol Phys. 1998 Jul 15;41(5):1063-7. doi: 10.1016/s0360-3016(98)00186-2.
To clarify the natural history of solitary plasmacytoma of bone (SBP) after radiation treatment.
Between 1965-1996, we identified 57 previously untreated patients with a SBP. A serum myeloma protein was present in 33 patients (58%) and Bence Jones proteinuria was present in an additional eight patients (14%). The median radiotherapy dose was 50 Gy (range, 30-70 Gy). Overall survival, cause-specific survival, and freedom from progression to multiple myeloma were calculated actuarially.
Local control was achieved in 55 of 57 patients (96%). For those 29 patients (51%) who subsequently developed multiple myeloma, the median time to progression was 1.8 years. There was a direct correlation between persistence of abnormal protein following radiotherapy and the likelihood of developing multiple myeloma. Among 11 patients with disappearance of myeloma protein, only two developed multiple myeloma after 4 and 12 years, in contrast to progression in 57% of patients with a persistent protein peak and 63 % of those with nonsecretory disease (p = 0.02). Among 23 patients with thoracolumbar spine disease, 7 of 8 patients staged with plain radiographs alone developed multiple myeloma in comparison with 1 of 7 patients who also had magnetic resonance imaging (MRI) (p = 0.08). For all patients, the median survival from radiotherapy was 11.0 years. The median cause-specific survival of patients with disappearance of myeloma protein was significantly longer than that of the remaining patients (p = 0.004).
Results supported the importance of precise staging that includes MRI of the spine for optimum patient selection and the application of definitive radiotherapy. Those patients with myeloma protein that disappears following radiotherapy represent a category with a high likelihood of cure.
阐明骨孤立性浆细胞瘤（SBP）放射治疗后的自然病程。
1965年至1996年间，我们确定了57例未经治疗的SBP患者。33例患者（58%）存在血清骨髓瘤蛋白，另有8例患者（14%）存在本-周蛋白尿。中位放射治疗剂量为50 Gy（范围30 - 70 Gy）。采用精算方法计算总生存率、病因特异性生存率以及无进展至多发性骨髓瘤生存率。
57例患者中有55例（96%）实现了局部控制。在随后发生多发性骨髓瘤的29例患者（51%）中，中位进展时间为1.8年。放射治疗后异常蛋白持续存在与发生多发性骨髓瘤的可能性之间存在直接相关性。在11例骨髓瘤蛋白消失的患者中，只有2例在4年和12年后发生了多发性骨髓瘤，相比之下，蛋白峰持续存在的患者中有57%进展，非分泌性疾病患者中有63%进展（p = 0.02）。在23例胸腰椎疾病患者中，仅通过X线平片分期的8例患者中有7例发生了多发性骨髓瘤，而同时进行磁共振成像（MRI）检查的7例患者中有1例发生（p = 0.08）。所有患者放射治疗后的中位生存期为11.0年。骨髓瘤蛋白消失的患者的中位病因特异性生存期显著长于其余患者（p = 0.004）。
结果支持精确分期（包括脊柱MRI）对于优化患者选择和应用根治性放射治疗的重要性。放射治疗后骨髓瘤蛋白消失的患者代表治愈可能性高的一类患者。
