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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.

Radiotherapy is well recognised as an effective treatment modality for Hodgkin lymphoma (HL), follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL), and is routinely incorporated into the treatment strategies for favourable-risk, limited stage disease to optimise local control and thereby improve progression-free survival. However, long-term survivors are at risk of late radiation-induced toxicities, including the risk of second malignancy. The rationale of involved node radiotherapy (INRT) is to reduce the size of the radiotherapy field to cover only the original sites of lymphoma, with the aim of lowering the incidence of radiation-induced toxicities whilst maintaining high rates of local lymphoma control. Reducing the radiotherapy field size lowers the radiation exposure to organs at risk, and this is likely to be associated with a lower incidence of radiation-induced toxicities. However, in practice it is difficult to quantify the risk of late toxicities due to the long latency period and the large numbers of patients required to detect the less common effects. Therefore, reducing the radiation dose parameters of organs at risk is proposed as a surrogate end point for lowered risks of late, radiotherapy-induced toxicities. The aims of this research are to assess the patterns of failure and survival rates of patients treated with INRT for favourable-risk, limited stage lymphoma (HL, FL, DLBCL), compared to patients receiving larger, conventional radiotherapy fields. For each lymphoma group, a population-based, retrospective study is performed to analyse these endpoints. Additionally, a radiotherapy planning study is performed on 10 randomly selected female patients with supra-diaphragmatic HL, to quantify the dosimetric advantages of INRT compared to larger conventional radiotherapy fields, on organs at risk of late toxicities. The results of these studies demonstrate that INRT fields can safely replace larger, conventional radiotherapy fields in pat