MULTI-INSTITUTIONAL ANALYSIS OF SOLITARY EXTRAMEDULLARY PLASMACYTOMA OF THE HEAD AND NECK TREATED WITH CURATIVE RADIOTHERAPY
MULTI-INSTITUTIONAL ANALYSIS OF SOLITARY EXTRAMEDULLARY PLASMACYTOMA OF THE HEAD AND NECK TREATED WITH CURATIVE RADIOTHERAPY
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DOI：
10.1016/j.ijrobp.2010.11.037
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发表时间：
2012-02-01
影响因子：
7
通讯作者：
Yamada, Syogo
中科院分区：
文献类型：
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作者：
Sasaki, Ryohei;Yasuda, Koichi;Yamada, Syogo
目的：探讨放射治疗头颈部孤立性髓外浆细胞瘤(EMPHN)的疗效和最佳治疗方法。方法：对1983年至2008年在日本23家医疗机构确诊的67例EMPHN患者进行回顾性分析。患者年龄中位数为(12~83岁)。中位剂量50Gy30~Gy.生存资料用Kaplan-Meier法计算。结果：中位随访时间为63个月。主要肿瘤部位为鼻腔或鼻腔36例(54%)，口咽或鼻咽16例(23%)，眼眶6例(9%)，喉3例(5%)。5年和10年局部控制率分别为95%和87%，5年和10年无瘤生存率分别为56%和54%。局部失败5例(7.5%)，远处转移12例(18%)，进展为多发性骨髓瘤8例(12%)。总共有18名患者死亡，其中10名(15%)患者死于EMPHN并发症。5年和10年总生存率分别为73%和56%。放射治疗和手术是唯一显著影响OS预后的因素(p=0.04)，而年龄、性别、放射剂量、肿瘤大小和化疗不能预测OS的预后。无一例发生严重急性并发症。结论：放疗对EMPHN患者安全有效。从生存率来看，放疗与手术相结合的疗效较好。这些发现需要通过对更多的EMPHN患者进行进一步研究来证实。(C)2012年爱思唯尔公司。
Purpose: The purpose of this study was to elucidate the efficacy and optimal method of radiotherapy in the management of solitary extramedullary plasmacytoma occurring in the head and neck regions (EMPHN).Methods and Materials: Sixty-seven patients (43 male and 24 female) diagnosed with EMPHN between 1983 and 2008 at 23 Japanese institutions were reviewed. The median patient age was 64 years (range, 12-83). The median dose administered was 50 Gy (range, 30-64 Gy). Survival data were calculated by the Kaplan-Meier method.Results: The median follow-up duration was 63 months. Major tumor sites were nasal or paranasal cavities in 36 (54%) patients, oropharynx or nasopharynx in 16 (23%) patients, orbita in 6 (9%) patients, and larynx in 3 (5%) patients. The 5- and 10-year local control rates were 95% and 87%, whereas the 5- and 10-year disease-free survival rates were 56% and 54%, respectively. There were 5 (7.5%), 12 (18%), and 8 (12%) patients who experienced local failure, distant metastasis, and progression to multiple myeloma, respectively. In total, 18 patients died, including 10(15%) patients who died due to complications from EMPHN. The 5- and 10-year overall survival (OS) rates were 73% and 56%, respectively. Radiotherapy combined with surgery was identified as the lone significant prognostic factor for OS (p = 0.04), whereas age, gender, radiation dose, tumor size, and chemotherapy were not predictive. No patient experienced any severe acute morbidity.Conclusions: Radiotherapy was quite effective and safe for patients with EMPHN. Radiotherapy combined with surgery produced a better outcome according to survival rates. These findings require confirmation by further studies with larger numbers of patients with EMPHN. (C) 2012 Elsevier Inc.