Does surgical excision have a role in the treatment of multiple myeloma?

Does surgical excision have a role in the treatment of multiple myeloma?

• A. Yes
• B. No
• C. Only in Solitary Lesions
• D. Yes, But Only With Chemotherapy

Answer: (B)

In multiple myeloma the disease is systemic, affecting bone marrow and multiple skeletal sites throughout the body. Therefore the goal is to control the clonal plasma cell proliferation with systemic therapy, not by removing individual lesions. Excisional surgery cannot eradicate or sufficiently reduce the widespread marrow disease, so it does not serve as disease-directed treatment. Surgery may be considered only for specific, non-disease-control reasons, such as stabilization of a structurally compromised bone (for example, impending fracture or spinal instability) or for obtaining a biopsy. Localized radiotherapy is more appropriate for focal bone lesions or soft-tissue plasmacytomas when needed. Thus, as a general treatment strategy for multiple myeloma, surgical excision is not part of the standard approach.

In multiple myeloma the disease is systemic, affecting bone marrow and multiple skeletal sites throughout the body. Therefore the goal is to control the clonal plasma cell proliferation with systemic therapy, not by removing individual lesions. Excisional surgery cannot eradicate or sufficiently reduce the widespread marrow disease, so it does not serve as disease-directed treatment.

Surgery may be considered only for specific, non-disease-control reasons, such as stabilization of a structurally compromised bone (for example, impending fracture or spinal instability) or for obtaining a biopsy. Localized radiotherapy is more appropriate for focal bone lesions or soft-tissue plasmacytomas when needed. Thus, as a general treatment strategy for multiple myeloma, surgical excision is not part of the standard approach.