Top Line: Is surgery or radiation more effective for extramedullary plasmacytoma of the head and neck?
The Study: Head and neck EMPs make up a small minority of plasma cell tumors, and they are often treated with radiation. With advancing surgical techniques for head and neck cancer, some have argued for surgical resection of solitary extramedullary plasmacytoma of the head and neck when feasible as the ideal definitive treatment. Enter this pooled analysis of 12 studies including 742 patients receiving either surgery (32%) or radiation (68%) for definitive management. Note: the typical definitive radiation dose in this setting is 45-50 Gy. Interestingly, despite no clear difference in local recurrence or overall survival between modalities, receipt of radiation slashed the risk of progression to systemic multiple myeloma (HR 0.37). The reason for this remains unclear though one can speculate radiation may contribute to immune modulation.
TBL: Definitive radiation to 45-50 Gy should be considered for all head and neck extramedullary plasmacytomas to maximize local and systemic control. | Vasudevan, JAMA Otolaryngol Head Neck Surg 2024
The Study: Head and neck EMPs make up a small minority of plasma cell tumors, and they are often treated with radiation. With advancing surgical techniques for head and neck cancer, some have argued for surgical resection of solitary extramedullary plasmacytoma of the head and neck when feasible as the ideal definitive treatment. Enter this pooled analysis of 12 studies including 742 patients receiving either surgery (32%) or radiation (68%) for definitive management. Note: the typical definitive radiation dose in this setting is 45-50 Gy. Interestingly, despite no clear difference in local recurrence or overall survival between modalities, receipt of radiation slashed the risk of progression to systemic multiple myeloma (HR 0.37). The reason for this remains unclear though one can speculate radiation may contribute to immune modulation.
TBL: Definitive radiation to 45-50 Gy should be considered for all head and neck extramedullary plasmacytomas to maximize local and systemic control. | Vasudevan, JAMA Otolaryngol Head Neck Surg 2024