Radiotherapy Alone is Associated with Improved Outcomes Over Surgery in the Management of Solitary Plasmacytoma

Abstract

Background: A moderate dose of radiation is the recommended treatment for solitary plasmacytoma (SP), but there is controversy over the role of surgery. Our study aimed at comparing different treatment modalities in the management of SP. Materials and Methods: Data from 38 consecutive patients with solitary plasmacytoma, including 16 with bone plasmacytoma and 22 with extramedullary plasmacytoma, were retrospectively reviewed. 15 patients received radiotherapy alone; 11 received surgery alone, and 12 received both. The median radiation dose was 50Gy. All operations were performed as radical resections. Local progression-free survival (LPFS), multiple myeloma-free survival (MMFS), progression-free survival (PFS) and overall survival (OS) were calculated and outcomes of different therapies were compared. Results: The median follow-up time was 55 months. 5-year LPFS, MMFS, PFS and OS were 87.0%, 80.9%, 69.8% and 87.4%, respectively. Univariate analysis revealed, compared with surgery alone, radiotherapy alone was associated with significantly higher 5-year LPFS (100% vs 69.3%, p=0.016), MMFS (100% vs 51.4%, p=0.006), PFS (100% vs 33.7%, p=0.0004) and OS (100% vs 70%, p=0.041). Conclusions: Radiotherapy alone can be considered as a more effective treatment for SP over surgery. Whether a combination of radiotherapy and surgery improves outcomes requires further study.

Management of extramedullary plasmacytoma: Role of radiotherapy and prognostic factor analysis in 55 patients

“…The majority of patients (70.9%) presented with disease in the head or neck regions and had a favourable prognosis. These results are similar to the data reported by others (3,(12)(13)(14).…”

“…EMP is well known to be radiation sensitive, and several investigators have demonstrated that high LC rates of 85%-100% can be achieved with adequate doses of RT (2,8,14,15,24). In our series, the LRFS of the patients who received RT was 89.1% at 5 years, which is consistent with previous reports.…”

“…All patients met the following diagnostic criteria: 1) one solitary lesion confirmed by a tissue biopsy (fine-needle or open) revealing plasma cell histology; 2) the absence of skeletal lytic lesions or other tissue involvement verified by imaging examination; 3) bone marrow aspirate/biopsy specimen with less than 5% plasma cells; and 4) no anaemia, hypercalcaemia or renal impairment due to plasma cell dyscrasia (9,14). After treatment, the patients were followed up by out-patient re-examination, phone calls and correspondence.…”

Solitary plasmacytoma: population-based analysis of survival trends and effect of various treatment modalities in the USA

“…To date, a consensus has not been reached regarding the role of surgery in improving survival rates. Recently, Li QW et al reported that the outcomes yielded by RT alone were superior to those achieved in SP patients who underwent surgery [14]. However, when interpreting these findings, it is important to note that their study was conducted at a single institution and included only 38 SP patients.…”

Survival of patients with lymphoplasmacytic lymphoma and solitary plasmacytoma in Germany and the United States of America in the early 21 st century

“…38,39 Although excellent results are obtained for most patients, a certain number will progress to myeloma. vival for patients initially diagnosed with SP.…”