髓外浆细胞瘤临床分析

目的探讨髓外浆细胞瘤的生物学行为和临床特点,以帮助临床诊断、治疗及对预后的判断。方法对40多年来笔者所在科室收治的28例髓外浆细胞瘤进行回顾性分析,其中单纯放射治疗16例(57.1%),综合治疗11例(39.3%),单纯手术1例(3.6%)。结果中位随访90个月(4～280个月),2例(7.1%)局部复发,2例(7.1%)转化为多发性骨髓瘤。3、5、10年总生存率分别为92.6%、75.6%和75.6%;单纯放射治疗组与综合治疗组3、5、10年总生存率分别为93.8%、77.3%、77.3%和90.9%、72.7%、72.7%(P>0.05)。结论单纯放射治疗是治疗髓外浆细胞瘤最有效的方法之一,局部放射治疗DT40Gy～50Gy后,可获得良好的局部控制率和长期生存率。部分髓外浆细胞瘤可向多发性骨髓瘤转化,故需密切观察。

Treatment of extramedullary plasmacytoma

Objective To analyze the clinical feature of extramedullary plasmacytoma (EMP) and treatment results. Methods From Jan. 1960 to Aug. 2000, 28 EMP patients accumulated in a period of 40 odd years were evaluated retrospectively. Sixteen of them were treated with radiotherapy alone (R group,57.1%) with a median dose of 50?Gy, 11 with combined modality therapy (CMT group,39.3%) and 1 with surgery alone (S group,3.6%). Results During a median follow up of 90 months (4 280 months), 2 developed local recurrence and 2 were converted to multiple myeloma. The overall 3 , 5 , and 10 year survival rates were 92.6%,75.6% and 75.6% ,respectively. In the R group, the overall 3 , 5 , and 10 year survival rates were 93.8%, 77.3% and 77.3%, as compared with 90.9%, 72.7% and 72.7% in the CMT group (P>0.05). Conclusions Extramedullary plasmacytoma may well be cured with small field and limited dose of radiation therapy alone. The diagnosis of extramedullary plasmacytoma requires a complete work up (including MRI) and strict criteria to exclude multiple myeloma. Close follow up is necessary in those converted to multiple myeloma.