Ⅰ～Ⅱ期鼻腔结外NK/T细胞淋巴瘤放射治疗疗效分析

Radiotherapy as primary treatment for stageⅠ-Ⅱ extranodal natural killer/T-cell lymphoma,nasal type:Analysis of treatment outcomes

目的:探讨Ⅰ～Ⅱ期鼻型结外NK/T细胞淋巴瘤根治性放疗的方法以及以放疗为主的综合治疗的疗效。方法:2005年9月—2009年4月连续收治的193例经病理学证实的、原发灶位于上呼吸道的Ⅰ～Ⅱ期结外NK/T细胞淋巴瘤患者,行根治性放疗,总剂量为50Gy/25次,联合或不联合以CEOP或DICE方案为主的诱导化疗。放疗范围为区域野。放疗技术采用三维适形或调强放疗。观察治疗反应率、局部和区域复发率以及生存情况。结果:全组患者的3年生存率为73.7%,3年无进展生存率为66.4%。24例接受单纯放疗患者的完全缓解率为100%。放化疗组有169例患者,其中4例因化疗中出现疾病进展而未行放疗,剩余165例接受放疗的患者中有147例达CR。3年局部控制率为90.3%。41例患者发生远处转移。多因素分析显示,原发灶累及范围与3年无进展生存期以及野内/边缘复发相关。结论:目前区域野的Ⅰ～Ⅱ期鼻型结外NK/T细胞淋巴瘤的肿瘤放疗剂量50Gy可以获得较好的反应率和较低的局部复发率。今后需要设计更有效的化疗方案以减少远处转移。

Objective：To investigate the parameters of radiotherapy as well as the treatment outcome of patients with stage Ⅰ-Ⅱ extranodal natural killer（NK） /T-cell lymphoma receiving radiotherapy as primary treatment.Methods：One hundred and ninety-three patients diagnosed as having stage Ⅰ-Ⅱ extranodal NK/T-cell lymphoma,nasal type were recruited consecutively from September 2005 to April 2009.They were treated with definitive radiotherapy alone with a prescribed dose of 50 Gy in 25 fractions or 2-4 cycles of CEOP or DICE regimen as induction chemotherapy followed by radiation therapy.Clinical target volume of radiation was defined as regional field covering involved anatomic structure（s） and the adjacent structures.Radiation was delivered with three-dimensional conformal or intensity-modulated radiotherapy technique.The local control,treatment response and survival were observed.Results：The three-year overall survival and progression-free survival were 73.7% and 66.4%,respectively.Twenty-four patients who were treated with radiotherapy alone all obtained complete remission（100%）.Of 169 patients in chemoradiotherapy group,4 patients did not receive radiotherapy due to progressive disease.Of the remaining 165 patients,147 patients achieved complete remission.The three-year local control rate was 90.3%.Systemic recurrence was observed in 41 cases.The multivariate analysis revealed that the extent of primary tumor was correlated with three-year progression-free survival and in-field or marginal recurrence.Conclusion：This study confirms that the regional-field radiotherapy with a total dose of 50 Gy results in a high response rate and satisfying local control rate of stage Ⅰ-Ⅱ extranodal natural killer/T-cell lymphoma,nasal type.More effective chemotherapy regimens should be considered to reduce the system failure in future trials.