Radiotherapy Cuts Myeloma Risk in Rare Head and Neck Cancer

TOPLINE: 

In patients with extramedullary plasmacytoma of the head and neck, radiotherapy and surgery provide comparable survival outcomes, but radiotherapy significantly reduced the risk for progression to multiple myeloma, a new meta-analysis found.

METHODOLOGY:

• Extramedullary plasmacytomas are rare, aggressive tumors that can progress to multiple myeloma. Radiotherapy and surgery are commonly used alone or in combination to treat these rare tumors, which typically develop in the head and neck. However, there is no clear consensus on the most effective approach.
• Researchers conducted a meta-analysis of 12 studies which involved 742 patients (median age, 59.1 years; 71% men) with extramedullary plasmacytoma of the head and neck who underwent either radiation therapy (n = 505) or surgery (n = 237).
• Median radiation dose was 50 Gy (42.5-50.7 Gy), and 86.6% of patients received doses of 45 Gy or higher.
• Seven studies were conducted in North America (58%), three in Europe (25%), and two in China (17%).
• The main outcomes were overall survival, disease-free survival, local recurrence rates, and progression to multiple myeloma.

TAKEAWAY:

• Based on data from seven studies, overall survival outcomes did not differ significantly between patients who received radiation therapy and those who underwent surgery at 5 years (hazard ratio [HR], 0.83; 95% CI, 0.52-1.31) or at 10 years (HR, 1.1; 95% CI, 0.80-1.52).
• Based on data from 5 studies, disease-free survival outcomes did not differ significantly between the two treatment groups at 5 years (odds ratio [OR], 0.68; 95% CI, 0.41-1.11). However, disease-free survival at 5 years favored radiotherapy when one study was excluded in the sensitivity analyses (HR, 0.55; 95% CI, 0.31-0.96). And based on data from four studies, disease-free survival outcomes were also similar between the two treatment groups at 10 years (HR, 0.88; 95% CI, 0.55-1.42).
• Of eight studies that assessed recurrence, local recurrence rates were also not significantly different between the two treatment options (OR, 0.65; 95% CI, 0.20-2.06).
• However, based on data from six studies, patients who received radiation therapy were 63% less likely to progress to multiple myeloma (OR, 0.37; 95% CI, 0.15-0.94), possibly because radiotherapy led to “sufficient coverage over microscopic residual tumor, which can be missed in surgical excisions,” the authors suggested.

IN PRACTICE:

“Our meta-analysis confirms that radiotherapy may represent an optimal treatment strategy associated with a lower progression rate of multiple myeloma,” the authors wrote.

SOURCE:

The study, led by Srivatsa Surya Vasudevan, MD, MS, Louisiana State University Health Sciences Center in Shreveport, Louisiana, was published online in JAMA Otolaryngology-Head & Neck Surgery.

LIMITATIONS:

The retrospective design of the included studies could introduce selection bias. Most study results showed moderate to severe heterogeneity. Additionally, there was limited information on the duration of follow-up and the details of patients who progressed to multiple myeloma.

DISCLOSURES:

The authors did not disclose any funding information or conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.