Analysis of the effectiveness of teleradiotherapy with modulation of beam intensity in the extramedullary plasmacytoma of the head and neck region: A new look at inductive systemic treatment

Abstract

Introduction: Extramedullary plasmacytoma (EMP) is a very rare malignancy. EMP is highly radiosensitive. Local disease control can be obtained by administering a dose of 45–50 Gy. Relatively rarely, in less than 20% of cases, a progression of EMP to the systemic form of multiple myeloma (MM) may be observed. Material/Methods: This paper presents a retrospective analysis of 5 patients with EMP of the head and neck region, treated in 2009–2016 with the use of intensity modulated radiation therapy (IMRT). In three of the five patients, the tumor was located in the larynx; in one case, it was located in the nasopharynx and one in the maxillary sinus. All patients were qualified for definitive radiotherapy using the IMRT technique. Two patients with EMP located in the nasopharynx and in the maxillary sinus, with tumor sizes of 10 cm and 8 cm, respectively, received induction systemic treatment to improve the anatomical conditions for the planned radiotherapy and to reduce associated radiation doses in critical organs. Results: The effect of radiotherapy with modulation of beam intensity on local, regional and remote control in patients with EMP of the head and neck region was analyzed. The median of the dose used was 50 Gy. During the observation period of maximum 29 months (median: 26 months), all patients (100%) remained without disease recurrence and progression to the MM. Conclusion: IMRT leads to very good results in the form of local and regional control in patients with EMP of head and neck region. Based on the discussion, which is not a direct result of the study, in cases of extensive tumor mass or close proximity of critical organs, it seems justified to use inductive systemic treatment.