ⅠE～ⅡE期鼻腔NK／T细胞淋巴瘤的放疗效果分析

Outcome of radiotherapy for localized Stage ⅠE and ⅡE nasal NK/T cell lymphoma

目的 分析ⅠE～ⅡE期鼻腔NK／T细胞淋巴瘤以放疗为主的治疗结果。方法 1983年1月至2003年12月共收治105例经免疫组化证实的Ⅰ～Ⅱ期原发鼻腔T／NK细胞淋巴瘤。根据Ann Arbor分期，Ⅰ期83例，ⅡE期22例。根据原发肿瘤局限于鼻腔或直接侵犯邻近器官，将Ann ArborⅠE期分为局限ⅠE期（37例）和超腔ⅠE期（46例）。全组31例接受单纯放疗，34例放疗后化疗，37例化疗后放疗，3例单纯化疗。结果 全组5年总生存率（OS）和无进展生存率（PFS）分别为71％和59％。ⅠE、ⅡE期5年OS分别为78％、46％（P〈0．01），5年PFS分别为63％、40％（P〈0．01）。91例（87％）治疗后达完全缓解（CR）。接受先放疗的65例中，54例达CR（83％）；而先接受化疗的40例中，仅有8例达CR（20％）。接受单纯放疗或综合治疗的102例中，单纯放疗的5年OS、PFS分别为66％、61％，综合治疗的分别为76％、61％（P〉0．05）。结论 早期鼻腔NK／T细胞淋巴瘤对常规化疗的反应率明显低于放疔。放疗为主的治疗能取得较好治疗效果，化疗加入放疗未显著改善患者的生存率。

Objective With the optimal therapy remains unclear for nasal NK/T cell lymphoma, the aim of this study is to analyze the outcome of radiotherapy as primary treatment for localized stage ⅠE and ⅡE diseases. Methods Between January 1983 and December 2003, 105 patients with stage ⅠE and Ⅱ E primary nasal NK/T cell lymphoma were retrospectively reviewed. According to the Ann Arbor Staging System, there were 83 stage ⅠE and 22 stage Ⅱ E. Stage Ⅰ E was subdivided into limited stage ⅠE confined to the nasal cavity （37 patients）, or extensive stage ⅠE with an extension beyond the nasal cavity （46 patients）. Thirty-one patients received radiotherapy alone. Thirty-four patients were treated with radiotherapy followed by 2-4 cycles of chemotherapy. Thirty-seven patients were treated with chemotherapy followed by radiotherapy and 3 with chemotherapy alone. Of 83 patients with stage ⅠE disease, 26 were primarily treated with radiotherapy alone, 30 with radiotherapy followed by chemotherapy, and 27 with chemotherapy foUowed by radiotherapy. Results The five-year overall survival COS） and progression-free survival rates （PFS） for all patients was 71% and 59%, respectively. The 5-year OS for stage ⅠE and stage ⅡE was 78% and 46% （ P 〈 0.01）, while the 5-year PFS for stage Ⅰ E and stage ⅡE was 63% and 40%, respectively （ P 〈 0.01）. Patients with limited stage Ⅰ E had a better OS and PFS than those with extensive stage 1 E, with 5-year OS and PFS of 82% and 80% versus 75% and 45%, respectively. Complete response （CR） was achieved in 91 （87%） patients after radiotherapy and/or chemotherapy. Initial radiotherapy resulted in a superior CR as compared to initial chemotherapy, with 54 of 65 （83 % ） patients achieving CR with initial radiotherapy, versus only 8 of 40 （20%） with initial chemotherapy. For 102 patients who received radiotherapy with or without chemotherapy, the outcome of primary treatment with radiotherapy alone was compared to that of CMT. Five-year OS and PFS was 66% and 61% for radiotherapy alone and 76% and 61% % for CMT, respectively （ P = 0.64 for OS, P = 0.84 for PFS）. As to the 83 stage ⅠE patients, there was no difference in 5- year OS and PFS between the radiotherapy alone group and the CMT group, with a 5-year OS and PFS of 73% and 63% for radiotherapy alone, and 80% and 64% for CMT, respectively （ P = 0.93 for OS, P = 0.85 for PFS）. Condusions In this large cohort study of stage Ⅰ E and Ⅱ E nasal NK/T cell lymphoma, the response to initial conventional chemotherapy is found to be much lower than that to initial radiotherapy. Radiotherapy, as the primary therapy, can result in an outcome good enough, and the addition of chemotherapy to radiotherapy is not accompanied with any improvement in survival.