How is solitary plasmacytoma treated?

Updated: Dec 31, 2019
  • Author: Suzanne R Fanning, DO; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Due to the rarity of solitary plasmacytoma (SP), there are no randomized studies to inform the best treatment approach, and the available data from small case series are controversial. Radiotherapy is the treatment of choice for SP, although its efficacy has been tested only in small retrospective series. [43]

Experts have yet to reach a consensus regarding the optimal treatment modality for extramedullary plasmacytoma (EMP). Current guidelines stipulate that head and neck EMP be treated with radiotherapy only, as surgical resection of these tumors can be highly invasive. [45]

Chemotherapy, with regimens used in multiple myeloma, may be considered. Mignot et al reported that combining lenalidomide plus dexamethasone with radiation therapy improved myeloma-free survival and progression-free survival, compared with radiation therapy alone, in patients with SP. [46]

In the retrospective study by Thumallapally et al, 825 patients (49%) received radiotherapy and 197 (12%) underwent surgery, while 359 patients (21%) required both radiotherapy and surgery. The majority of SBP patients received radiation, while patients with EMP of upper airway tract and the central nervous system most commonly received radiotherapy plus surgery; those with lower airway tract involvement received radiotherapy only or neither radiotherapy nor surgery, and those with gastrointestinal tract localization were more frequently treated with surgery only. [2]

The survival rates of patients treated with radiotherapy were significantly higher than those of patients who did not receive radiotherapy (64.4% vs. 48.6%, P < 0.05). Moreover, patients who received neoadjuvant radiotherapy had a greater chance of 5-year relative survival than those who received adjuvant radiotherapy (86% vs. 73%, P < 0.05). A significant difference in survival was also observed in patients who underwent surgery, compared with patients who did not (69.7% vs 57.4%, P < 0.05). [2]


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