Solitary plasmacytoma treated with radiotherapy: Impact of tumor size on outcome
Solitary plasmacytoma treated with radiotherapy: Impact of tumor size on outcome
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DOI：
10.1016/s0360-3016(00)01572-8
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发表时间：
2001-05-01
影响因子：
7
通讯作者：
Stewart, AK
中科院分区：
文献类型：
--
作者：
Tsang, RW;Gospodarowicz, MK;Stewart, AK
目的：孤立性浆细胞瘤（SP）是一种罕见的浆细胞肿瘤。与多发性骨髓瘤相比，局部放疗（RT）后长期无病生存和治愈是可能的，特别是软组织表现。在这项研究中，我们试图确定预测局部衰竭、进展为多发性骨髓瘤和主要接受局部放疗的患者无病生存（DFS）的因素。方法和材料：我们确定了1982年至1993年在玛格丽特医院转诊的46例患者，中位年龄为63岁（35-95岁），男女比例为1.9:1，所有患者均有活检证实的SP（骨性：32，软组织：14），m蛋白异常19例（41%）。所有患者均接受局部放疗（中位剂量为35 Gy）， 5例患者（11%）同时接受化疗，放疗前最大肿瘤大小范围为0至18 cm（中位2.5）。结果：8年总生存率、DFS和无骨髓瘤率分别为65%、44%和50%，局部控制率为83%，骨髓瘤进展（DFS较差）的预测因素包括骨表现和年龄。然而，这两个因素不影响局部控制，局部控制受肿瘤大小的影响。肿瘤体积< 5cm（34例）均采用RT控制，解剖位置与预后无关；然而，5例鼻窦肿瘤中有3例没有得到局部控制，较低的放射治疗剂量（35 Gy）与较高的局部衰竭风险无关。结论：孤立性浆细胞瘤虽与系统性骨髓瘤一样具有较高的复发率，但中等剂量的放射治疗能有效地治疗孤立性浆细胞瘤，局部肿瘤体积较大（大于或等于5cm）预示局部治疗失败。对这些高危患者应探讨联合化疗和放疗，以提高局部控制率和治愈率。(C) 2001爱思唯尔科学公司
Purpose: Solitary plasmacytoma (SP) is a rare presentation of plasma cell neoplasms. In contrast to multiple myeloma, long-term disease-free survival and cure is possible following local radiotherapy (RT), particularly for soft tissue presentations. In this study, we attempt to identify factors that predict for local failure, progression to multiple myeloma, and disease-free survival (DFS) in patients mainly managed with local RT,Methods and Materials: We identified 46 patients referred to the Princess Margaret Hospital between 1982 and 1993, The median age was 63 years (range 35-95), with a male:female ratio of 1,9:1, All patients had biopsy-proven SP (osseous: 32, soft tissue: 14), M-protein was abnormal in 19 patients (41%). Ail patients were treated with local RT (median dose 35 Gy), with 5 patients (11%) also receiving chemotherapy, Maximum tumor size pre-RT ranged from 0 to 18 cm (median 2.5),Results: The 8-year overall survival, DFS, and myeloma-free rates were 65%, 44%, and 50%, respectively, The local control rate was 83%, Factors predictive of progression to myeloma land poorer DFS) included bone presentation and older age. However, these two factors did not influence local control, which was affected by tumor size. All tumors < 5 cm in bulk (34 patients) were controlled by RT, Anatomic location did not predict outcome; however, 3 of the 5 tumors arising in paranasal sinuses did not achieve local control, Lower RT dose (35 Gy) was not associated with a higher risk of local failure.Conclusion: Solitary plasmacytomas are effectively treated with moderate-dose RT, although osseous tumors have a high rate of recurrence as systemic myeloma, Large tumor bulk locally (greater than or equal to5 cm) predicts for local failure. Combined chemotherapy and RT should be investigated in these high-risk patients to increase the local control rate and the cure rate. (C) 2001 Elsevier Science Inc.