ROLE OF ENDOPROSTHETIC REPLACEMENT FOR SOLITARY BONE PLASMACYTOMAS IN LONG BONES

Abstract

Purpose: The aim of this study was to understand the effect of endoprosthetic reconstruction in treatment of solitary bone plasmacytoma threatening structural integrity of bone.

Materials and methods: We retrospectively studied 11 patients who underwent endoprosthetic reconstruction for solitary bone plasmacytoma between 1988 and 2003 with more than 1 year follow up. Most had radiotherapy and those who sustained structural damage to a joint or thought to be salvageable were treated with endoprosthetic replacement.

Results: There were 7 males and 4 females, with M: F ratio of 1.75:1, the median age at diagnosis was 53.61years (35–74). Average duration of symptoms prior to presentation at oncology unit was 7.27 months. We had 4 proximal femoral, 2 pelvic, 4 humeral and one tibial Plasmacytomas that were treated with endoprosthetic replacements.8/11 had preoperative radiotherapy for at least 4weeks and 3 did not. Two had postoperative radiotherapy and one adjuvant chemotherapy. Average follow up is 5.45 years (range 1–16years). We had one death due to unrelated causes, one progression to Myeloma treated with adjuvant chemotherapy, two revisions and one dislocation which was reduced by open method. The cumulative overall survival for all patients was 91% at 5 years. The cumulative risk of failure of reconstruction including; infection, dislocation, local recurrence/progression to Myeloma was 27% at 5 years.

Conclusion: Literature review shows that nearly 53% of SBP progress despite radiotherapy to Myeloma at a median time of 1.8 years (2–4 years). But despite average follow up of 5.45 years, progression to Myeloma after endoprosthetic replacement at our unit is 9.09%. We concluded that the use of endoprostheses for reconstruction after excision of solitary bone plasmacytomas threatening structural integrity of bone combined with radiotherapy decreases the disease progression to Myeloma than radiotherapy alone and offers a reasonable but not absolute chance of cure.