How do you treat a gastric plasmacytoma which is not amenable to radiation?

This is a very difficult case. Plasmacytomas are very responsive to radiation. you need to determine reason for not doing radiation: is it location, active bleeding, Perforation? Location should not be a big problem for Radiation oncologist. they can use precision tools now to avoid other structures. Active bleeding from the plasmacytoma should not be a contraindication to radiation. Infact it should be a good reason to radiate. I have requested an 11 cm bladder plasmacytoma causing gross hematuria, to be radiated. It was so amazing how that radiation worked. after 2-3 sessions, gross hematuria ceased. of course, if there is perforation, then surgical procedure needs to be done. Other than in this situation, surgery is not indicated. if rad...