Course

Tsang et al.9 reported local recurrence in 7% of patients receiving tumoricidal radiation. All local failures were in patients with bulky tumors 5 cm or more in diameter. Progression to multiple myeloma occurs in 10-15% of patients, which is much less common than in patients with solitary plasmacytoma of bone.9'202425

In one review, the overall 5-year survival rate with pulmonary plasmacytoma was 40%,23 whereas it was 60-82% in three separate series of patients with plasmacytoma mainly in the head and neck region.24-26 A detailed literature search found that there were more than 400 publications between 1905 and 1997.20 The median overall duration of survival was more than 25 years for patients who received a combination of radiation and surgery. Median duration of survival for patients receiving surgical intervention only was 13 years, whereas it was 12 years for those receiving radiation therapy alone. Overall, 61% had no recurrence or development of multiple myeloma; 22% had recurrence of extramedullary plasmacytoma; and 16% had conversion to multiple myeloma.

Extramedullary plasmacytoma may be classified as low-, intermediate-, or high-grade, depending on histo-logic grading. In one study, local control after radiation therapy was achieved in 15 of 18 patients (83%) with low-grade disease and in only 1 of 6 patients (17%) with intermediate- to high-grade tumors.24

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