Maximizing the Clinical Benefit of Radiotherapy in Solitary Plasmacytoma: An International Multicenter Analysis
Abstract
:1. Objective
2. Materials and Methods
3. Statistical Analysis
Definition of Response
4. Results
4.1. Treatments Administered
4.2. Response Rates
4.3. Survival Rates
4.4. Relapse Pattern
4.5. Toxicities
4.6. Cox proportional Hazard Model
5. Discussion
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Characteristic | Nr. (% or Range) | Site of Solitary Plasmacytoma | ||
---|---|---|---|---|
Extramedullary | Bone | p-value | ||
Patients | 84 | 30 (36%) | 54 (64%) | |
Median Age | 57 y (22–81) | 53 (22–81) | 60 (28–77) | 0.2 |
Gender | M: 55 (65 %) F: 29 (35 %) | 22 (73%) 8 (27%) | 33 (61%) 21 (39%) | 0.3 |
Immunohistochemical analysis | 0.3 | |||
Kappa light chain restriction | 25 (30%) | 12 (40%) | 13 (24%) | |
Lambda light chain restriction | 25 (30%) | 10 (33%) | 15 (28%) | |
Both | 2 (2%) | 0 (0%) | 2 (4%) | |
Maximum diameter | 0.16 | |||
In cm | 4 (0.7–9.6) | 3.6 (0.7–7.9) | 4.1 (1.3–9.6) | |
Serum Beta-2-microglobulin | 0.1 | |||
Elevated | 4 (5%) | 1 (3%) | 3 (6%) | |
Serum protein | 0.17 | |||
Elevated | 7 (8%) | 2 (7%) | 5 (9%) | |
Low | 5 (6%) | 3 (10%) | 2 (4%) | |
Serum albumin | 0.02 | |||
g/dL | 4.5 (2.6–5.4) | 4.6 (3.6–5.4) | 2.8 (2.6–3) | |
Hemoglobin | 0.06 | |||
g/dL | 13.3 (9–16.6) | 14.1 (9.6–16.6) | 13.2 (9–14.8) | |
Serum protein immunofixation | 0.3 | |||
Positive | 36 (43%) | 11 (37%) | 25 (46%) | |
Negative | 29 (34%) | 13 (43%) | 16 (30%) | |
Unknown | 19 (23%) | 6 (20%) | 13 (24%) | |
Serum LDH | 0.13 | |||
Elevated | 5 (6%) | 5 (17%) | 0 (0%) | |
Bence-Jones proteinuria | 0.12 | |||
Yes | 12 (14%) | 6 (20%) | 6 (11%) | |
Sites of RT | <0.001 | |||
Head and neck | 29 (34%) | 24 (80%) | 5 (9%) | |
Thorax | 28 (33%) | 2 (7%) | 26 (48%) | |
Abdomen | 2 (2%) | 0 | 2 (4%) | |
Pelvis | 21 (25%) | 4 (13%) | 17 (32%) | |
Extremities | 4 (5%) | 0 | 4 (7%) |
Characteristic | Nr. (% or Range) | Site of Solitary Plasmacytoma | ||
---|---|---|---|---|
Extramedullary | Bone | p-value | ||
Type of surgery | <0.001 | |||
Resection | 20 (24%) | 15 (50%) | 5 (9%) | |
Biopsy | 64 (76%) | 15 (50%) | 49 (91%) | |
Systemic therapy | 0.004 | |||
Yes | 28 (33%) | 4 (13%) | 24 (44%) | |
No | 56 (67%) | 26 (87%) | 30 (56%) | |
Timing of systemic therapy | ||||
Prior to RT alone | 5/28 (18%) | 2/4 (50%) | 3/24 (12%) | <0.001 |
Adjuvant alone | 21/28 (75%) | 0/4 (0%) | 21/24 (88%) | |
Both | 2 (7%) | 2/4 (50%) | 0/24 (0%) | |
Radiation parameters | ||||
Med. radiation dose (range), Gy | 42 (30–59.4) | 50 (36–59.4) | 40 (30–59.4) | <0.001 |
Radiation doses | <0.001 | |||
≤40 Gy | 44 (53%) | 3 (10%) | 41 (76%) | |
>40–50 Gy | 22 (26%) | 16 (53%) | 6 (11%) | |
>50 Gy | 18 (21%) | 11 (37%) | 7 (13%) | |
Med. fraction dose (range), Gy | 2 (1.8–3) | 2 (1.8–3) | 2 (1.8–2) | 0.03 |
Follow-up, m | 46 (2–154) | 40 (2–154) | 52 (2–149) | 0.4 |
Follow-up, IQR | 53 | 48 | 55 | |
RT technique | 0.02 | |||
Proton therapy | 4 (5%) | 4 (13%) | 0 | |
IMRT | 64 (76%) | 22 (74%) | 42 (78%) | |
3D-CRT | 16 (19%) | 4 (13%) | 12 (22%) | |
Response to RT | 0.7 | |||
Yes | 81 (96%) | 29 (97%) | 52 (96%) | |
No | 3 (4%) | 1 (3%) | 2 (4%) | |
Type of response | <0.001 | |||
CR | 39/81 (48%) | 25/29 (86%) | 14/52 (27%) | |
PR | 8/81 (10%) | 4/29 (14%) | 4/52 (8%) | |
SD | 34/81 (42%) | 0 | 34/52 (65%) | |
Relapse | 0.7 | |||
Yes | 29 (35%) | 9 (30%) | 20 (37%) | |
No | 55 (65%) | 21 (70%) | 34 (63%) | |
Pattern of relapse | 0.6 | |||
Local | 8 (10%) | 3/30 (10%) | 5/54 (9%) | |
Multiple myeloma | 21 (25%) | 6/30 (20%) | 15/54 (28%) |
Risk Factor | LRFS | MMFS | PFS | OS | ||||
---|---|---|---|---|---|---|---|---|
HR | p | HR | p | HR | p | HR | p | |
Univariate model | ||||||||
Age (years) | 1.06 | 0.09 | 1.005 | 0.8 | 1.034 | 0.06 | 1.085 | 0.08 |
EMP vs. SBP | 1.26 | 0.7 | 0.602 | 0.3 | 0.82 | 0.6 | 2.85 | 0.3 |
Diameter (cm) | 0.89 | 0.7 | 1.17 | 0.3 | 1.06 | 0.6 | 1.74 | 0.07 |
Bone erosion | 4.24 | 0.15 | 0.302 | 0.26 | 0.99 | 0.9 | 0.71 | 0.8 |
Surgical resection | 2.29 | 0.26 | 0.67 | 0.5 | 0.91 | 0.8 | 0.49 | 0.4 |
RT dose (>40 Gy vs. ≤40 Gy) | 0.38 | 0.2 | 1.39 | 0.5 | 1.12 | 0.7 | 1.92 | 0.5 |
Modern RT technique | 0.83 | 0.02 | 2.08 | 0.4 | 0.72 | 0.5 | 1.06 | 0.9 |
CR after RT | 1.39 | 0.6 | 0.42 | 0.09 | 0.67 | 0.3 | 1.01 | 0.9 |
B2-microglobulin (normal) | 6.0 | 0.2 | 3.22 | 0.1 | 0.31 | 0.08 | 0.285 | 0.3 |
Serum protein (normal) | 0.024 | 0.002 | 0.94 | 0.9 | 0.24 | 0.02 | 28.1 | 0.7 |
Hemoglobin (g/dl) | 1.32 | 0.5 | 0.67 | 0.006 | 0.68 | 0.004 | 0.91 | 0.7 |
Systemic therapy | 1.09 | 0.9 | 0.44 | 0.19 | 0.47 | 0.1 | 0.03 | 0.5 |
Multivariate model | ||||||||
Age (years) | - | - | - | - | - | - | 1.14 | 0.1 |
Diameter | - | - | - | - | - | - | 2.29 | 0.03 |
Modern RT technique | 0.036 | 0.012 | - | - | - | - | - | - |
Serum protein (normal) | 0.019 | 0.008 | - | - | - | - | - | - |
Hemoglobin (g/dl) | - | - | 0.676 | 0.006 | 0.655 | 0.004 |
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Elsayad, K.; Oertel, M.; König, L.; Hüske, S.; Le Ray, E.; Meheissen, M.A.M.; Elsaid, A.A.; Elfaham, E.; Debus, J.; Kirova, Y.; et al. Maximizing the Clinical Benefit of Radiotherapy in Solitary Plasmacytoma: An International Multicenter Analysis. Cancers 2020, 12, 676. https://doi.org/10.3390/cancers12030676
Elsayad K, Oertel M, König L, Hüske S, Le Ray E, Meheissen MAM, Elsaid AA, Elfaham E, Debus J, Kirova Y, et al. Maximizing the Clinical Benefit of Radiotherapy in Solitary Plasmacytoma: An International Multicenter Analysis. Cancers. 2020; 12(3):676. https://doi.org/10.3390/cancers12030676
Chicago/Turabian StyleElsayad, Khaled, Michael Oertel, Laila König, Sebastian Hüske, Emmanuelle Le Ray, Mohamed A.M. Meheissen, Amr Abdelaziz Elsaid, Essam Elfaham, Jürgen Debus, Youlia Kirova, and et al. 2020. "Maximizing the Clinical Benefit of Radiotherapy in Solitary Plasmacytoma: An International Multicenter Analysis" Cancers 12, no. 3: 676. https://doi.org/10.3390/cancers12030676