Bone Cancer: Diagnosis and Treatment Principles.

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Abstract

[Indexed for MEDLINE] 2. Int J Radiat Oncol Biol Phys. 2018 Jul 15;101(4):794-808. doi: 10.1016/j.ijrobp.2018.05.009. Epub 2018 Jun 20. Radiation Therapy for Solitary Plasmacytoma and Multiple Myeloma: Guidelines From the International Lymphoma Radiation Oncology Group. Tsang RW(1), Campbell BA(2), Goda JS(3), Kelsey CR(4), Kirova YM(5), Parikh RR(6), Ng AK(7), Ricardi U(8), Suh CO(9), Mauch PM(7), Specht L(10), Yahalom J(11). Author information: (1)Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: richard.tsang@rmp.uhn.on.ca. (2)Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. (3)Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India. (4)Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina. (5)Department of Radiation Therapy, Institut Curie, Paris, France. (6)Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. (7)Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts. (8)Radiation Oncology Unit, Department of Oncology, University of Torino, Torino, Italy. (9)Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea. (10)Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. (11)Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York. Erratum in Int J Radiat Oncol Biol Phys. 2018 Dec 1;102(5):1602. doi: 10.1016/j.ijrobp.2018.08.004. PURPOSE: To develop guidelines for the work-up and radiation therapy (RT) management of patients with plasma cell neoplasms. METHODS AND MATERIALS: A literature review was conducted covering staging, work-up, and RT management of plasma cell neoplasms. Guidelines were developed through consensus by an international panel of radiation oncologists with expertise in these diseases, from the International Lymphoma Radiation Oncology Group. RT volume definitions are based on the International Commission on Radiation Units and Measurements. RESULTS: Plasma cell neoplasms account for approximately one-fifth of mature B-cell neoplasms in the United States. The majority (∼95%) are diagnosed as multiple myeloma, in which there has been tremendous progress in systemic therapy approaches with novel drugs over the last 2 decades, resulting in improvements in disease control and survival. In contrast, a small proportion of patients with plasma cell neoplasms present with a localized plasmacytoma in the bone, or in extramedullary (extraosseous) soft tissues, and definitive RT is the standard treatment. RT provides long-term local control in the solitary bone plasmacytomas and is potentially curative in the extramedullary cases. This guideline reviews the diagnostic work-up, principles, and indications for RT, target volume definition, treatment planning, and follow-up procedures for solitary plasmacytoma. Specifically, detailed recommendations for RT volumes and dose/fractionation are provided, illustrated with specific case scenarios. The role of palliative RT in multiple myeloma is also discussed. CONCLUSIONS: The International Lymphoma Radiation Oncology Group presents a standardized approach to the use and implementation of definitive RT in solitary plasmacytomas. The modern principles outlining the supportive role of palliative RT in multiple myeloma in an era of novel systemic therapies are also discussed. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.ijrobp.2018.05.009