BOF: Malignant (Multiple Myeloma)

Solitary plasmacytoma of bone is more common in males than females and is commonest in the axial skeleton. Which ONE of the following is the best management of solitary plasmacytoma

a) Debulking surgery, steroids and systemic mutiagent therapy

b) Debulking surgery and radiotherapy

c) Debulking surgery, steroids, multiagent cytotoxic therapy and radiotherapy

d) Radiotherapy alone

e) Radical surgery to clear tumour margins

Answer:

d) Radiotherapy alone

Explanation:

Solitary plasmacytoma is more common in males than females (ratio 1.87:1) and eventually progresses to multiple myeloma in the majority of patients by 5 years. BCSH guidelines recommend radical radiotherapy (40 Gy in 20 fractions increased to 50Gy in 25 fractions if greater than 5cm in diameter) as the treatment of choice, encompassing the tumour volume, plus a margin of at least 2cm, as demonstrated by MRI. (Hughes et al., 2009) Surgery may well be indicated for relief of local symptoms or skeletal stabilisation. Surgery, with its attendant risks, produces no benefit over radiotherapy with respect to local disease control, even in combination with radiotherapy or chemotherapy.

Reference:

Hughes, M. et al. (2009) Guidelines on the diagnosis and management of solitary plasmacytoma of bone, extramedullary plasmacytoma and multiple solitary plasmacytomas: 2009 update. Prepared by a working group of UKMF Guidelines Working Group. British Committee for Standards in Haematology approved document.