Extramedullary Plasmacytoma Treatment & Management
- Author: Suzanne R Fanning, DO; Chief Editor: Emmanuel C Besa, MD more...
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- Solitary bone plasmacytoma (SBP)
- Local radiotherapy is the treatment of choice.[4, 5, 16, 29] Treatment fields should be designed to encompass all disease observed on MRI and should include a margin of healthy tissue (at least 2 cm). For spinal lesions, the margins should include at least 1 uninvolved vertebra.
- Local control is achieved in 88-100% of patients. Virtually all patients have major symptom relief. and a local tumor recurrence rate of approximately 10%.
- Most centers use approximately 40 Gy for spinal lesions and 45 Gy for other bone lesions. For lesions larger than 5 cm, 50 Gy should be considered.
- No dose-response relationship between radiation dose and disappearance of monoclonal protein was noted in a series of patients with solitary bone plasmacytoma as reported by Liebross et al.
- Monoclonal protein is markedly reduced after radiotherapy in the majority of patients, but protein disappearance is observed in only 20-50% of patients.
- Surgery is contraindicated in the absence of structural instability or neurologic compromise.
- Chemotherapy may be considered for patients not responding to radiation therapy. Regimens useful in multiple myeloma can be considered.
- No role exists for adjuvant chemotherapy in solitary bone plasmacytoma (SBP).
- Extramedullary plasmacytoma (EMP)
- Based on the documented radiation sensitivity of plasma cell tumors, the accepted treatment is radiotherapy.
- When a lesion can be completely resected, surgery provides the same results as radiotherapy.
- Combined therapy (surgery and radiotherapy) is an accepted treatment depending on the resectability of the lesion.[4, 6, 16, 17, 18] In fact, combination treatment may provide the best results.
- The optimal dose for local control is 40-50 Gy (depending on tumor size) delivered over 4-6 weeks.[16, 17, 18]
- Because of the high rate of lymph node involvement, these areas should be included in the radiation field.
- Adjuvant radiotherapy should be recommended to patients with positive surgical margins.
- Chemotherapy may be considered for patients with refractory or relapsed disease. Regimens used for multiple myeloma can be considered.
- Adjuvant chemotherapy may be considered for patients with tumors larger than 5 cm, as well as those with high-grade histology.
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- Although surgical resection is not advised for the treatment of solitary bone plasmacytoma (SBP), spine instrumentation or another procedure is sometimes necessary to try to reestablish the normal architecture of the spine or other bone affected.
- If possible, a complete resection of the lesion, including lymph node dissection, should be attempted for soft-tissue plasmacytomas.
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- Orthopedic evaluation is recommended for patients with solitary bone plasmacytoma (SBP) because lesions may cause spinal cord compression syndrome or impending fractures. Therapeutic procedures, such as kyphoplasty, can be implemented in order to restore vertebral structure.
- An ear, nose, and throat evaluation is recommended for patients with extramedullary plasmacytoma (EMP) of the head and neck to precisely localize the lesion, obtain an adequate biopsy (including lymph nodes), and plan possible resection.
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