Open Access Research article

Prognostic factors in solitary plasmacytoma of the bone: a multicenter Rare Cancer Network study

David Knobel1, Abderrahim Zouhair1, Richard W Tsang2, Philip Poortmans3, Yazid Belkacémi48, Michel Bolla5, Fazilet Dinçbas Oner6, Christine Landmann7, Bernard Castelain8, Mahmut Ozsahin1* and for the Rare Cancer Network

Author Affiliations

1 Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

2 Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada

3 Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands

4 Department of Radiation Oncology, Hôpital Tenon, Paris, France

5 Department of Radiation Oncology, Centre Hospitalier Universitaire, Grenoble, France

6 Department of Radiation Oncology, Cerrahpasa School of Medicine, Istanbul University, Turkey

7 Kantonsspital, Basel, Switzerland

8 Department of Radiation Oncology, Centre Oscar-Lambret, Lille, France

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BMC Cancer 2006, 6:118  doi:10.1186/1471-2407-6-118

Published: 5 May 2006

Abstract

Background

Solitary plasmacytoma (SP) of the bone is a rare plasma-cell neoplasm. There are no conclusive data in the literature on the optimal radiation therapy (RT) dose in SP. Therefore, in this large retrospective study, we wanted to assess the outcome, prognostic factors, and the optimal RT dose in patients with SP.

Methods

Data from 206 patients with bone SP without evidence of multiple myeloma (MM) were collected. Histopathological diagnosis was obtained for all patients. The majority (n = 169) of the patients received RT alone; 32 chemotherapy and RT, and 5 surgery. Median follow-up was 54 months (7–245).

Results

Five-year overall survival, disease-free survival (DFS), and local control was 70%, 46%, and 88%; respectively. Median time to MM development was 21 months (2–135) with a 5-year probability of 51%. In multivariate analyses, favorable factors were younger age and tumor size < 5 cm for survival; younger age for DFS; anatomic localization (vertebra vs. other) for local control. Older age was the only predictor for MM. There was no dose-response relationship for doses 30 Gy or higher, even for larger tumors.

Conclusion

Younger patients, especially those with vertebral localization have the best outcome when treated with moderate-dose RT. Progression to MM remains the main problem. Further investigation should focus on adjuvant chemotherapy and/or novel therapeutic agents.