title: The role of radiotherapy in the management of POEMS syndrome.
abstract: BACKGROUND
  POEMS syndrome is a paraneoplastic syndrome caused by an underlying plasma cell proliferative disease. In this study, we examined the treatment outcomes and role of radiotherapy in the management of POEMS syndrome.
  
  
  METHODS
  In total, 33 patients diagnosed with POEMS syndrome were analyzed. These patients presented with osteosclerotic myeloma (OSM, n = 13), Castleman's disease (CD, n = 4), OSM with CD (n = 10), and vascular endothelial growth factor elevation without gross lesions (VEGFe, n = 6), respectively. The patients were treated by radiotherapy alone (n = 4), chemotherapy alone (n = 16), or a combination thereof (n = 9).
  
  
  RESULTS
  The clinical response rates of radiotherapy, chemotherapy, and radiotherapy plus chemotherapy were 75%, 69%, and 89%, respectively. In addition, the hematologic response rates were 50%, 69%, and 71%, respectively. Among the six patients with limited multiple lesions who underwent radiotherapy, the clinical symptoms were improved in five patients after radiotherapy. The median progression-free survival (PFS) was 51 months, and the median overall survival (OS) was 65 months. In univariate analysis, the administration of chemotherapy was significantly associated with better PFS (p = 0.007) and OS (p = 0.020). In contrast, underlying VEGFe was a significant factor worsening PFS (p = 0.035) and OS (p = 0.008).
  
  
  CONCLUSIONS
  Radiotherapy produces a reliable clinical response and is effective in improving POEMS-associated symptoms that are refractory to chemotherapy in selected patients with clustered or limited multiple lesions that can be covered by single radiation field.
authors.affiliation: Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. suhmd@yuhs.ac.
authors.forename: Yang-Gun
authors.initials: YG
authors.lastname: Suh
authors.affiliation: Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. yskim@jejunuh.co.kr.
authors.forename: Young-Suk
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. cosuh317@yuhs.ac.
authors.forename: Chang-Ok
authors.initials: CO
authors.lastname: Suh
authors.affiliation: Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. glassy@yuhs.ac.
authors.forename: Yu Ri
authors.initials: YR
authors.lastname: Kim
authors.affiliation: Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. JWCHEONG70@yuhs.ac.
authors.forename: June-Won
authors.initials: JW
authors.lastname: Cheong
authors.affiliation: Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea. HEMAKIM@yuhs.ac.
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea. jjhmd@yuhs.ac.
authors.forename: Jaeho
authors.initials: J
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016878:POEMS Syndrome / Q000401:mortality / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome