鼻腔NK/T细胞淋巴瘤螺旋断层放射治疗疗效观察

Clinical study for patients with nasal NK/T cell lymphoma treated by tomotherapy

目的研究鼻腔NK/T细胞淋巴瘤螺旋断层放射治疗后的临床疗效及不良反应。方法对2008年8月-2013年4月我科收治的25例鼻腔NK/T细胞淋巴瘤患者进行螺旋断层放射治疗,该组中3例未行化疗,1例行同步放化疗,2例放疗后行序贯化疗,其余患者均行1-2周期诱导化疗后行放疗再行序贯化疗。所有患者的化疗方案均以CHOP-L方案（环磷酰胺＋多柔比星＋长春新碱＋泼尼松＋左旋门冬酰胺酶）为主,化疗总周期数均为1-7次,中位化疗周期数为4次。放疗均采用螺旋断层放射治疗,剂量GTV DT 50-56 Gy（中位剂量50 Gy）,单次剂量2-2.78 Gy,CTV剂量范围DT 36-50 Gy（中位剂量40 Gy）,单次剂量1.6-2 Gy。结果 25例放疗后达到完全缓解（complete remission,CR）14例,部分缓解（partial response,PR）4例,稳定（stable disease,SD）3例;2例失访,2例放疗后1个月内死亡。患者总有效率（CR＋PR）为78.3%,2年总生存率为92%,平均生存期55.3个月（95%置信区间49.0-61.5个月）。放疗后大部分患者出现不同程度的口干及味觉改变症状,少部分出现视力或听力下降,未出现脑损伤症状。结论相对于常规调强放射治疗,鼻腔NK/T细胞淋巴瘤螺旋断层放射治疗的临床疗效更优,不良反应更少。

Objective To study the clinical curative effect and adverse reaction of the nasal NK/T cell lymphoma treated by tomotherapy.Methods Of the 25 cases with nasal NK/T cell lymphoma treated by tomotherapy in our hospital from August 2008 to April 2013, three patients had no chemotherapy, 1 case underwent concurrent chemotherapy and radiotherapy, 2 cases underwent sequential chemotherapy after radiotherapy, the rest of the patients were performed 1-2 sequential chemotherapy cycle induction chemotherapy after radiotherapy. All patients were given priority to CHOP-L scheme chemotherapy, with the total chemotherapy cycles of 1-7 times and the median cycles of chemotherapy for 4 times. Tomotherapy were performed in patients with the GTV DT of 50 - 56 Gy （median dose 50 Gy） and the single dose of 2 - 2.78 Gy, CTV DT of 36 - 50 Gy （median dose 40 Gy） and the single dose of 1.6 - 2 Gy.Results Of all the 25 patients after radiotherapy, 14 cases reached to CR, 4 cases reached to PR, 3 cases reached to PD, 2 cases lost of follow-up, 2 patients died within a month after radiotherapy. The total effective rate of （CR ＋ PR） was 78.3%, and the total 2 years survival rate was 92% with the average survival period of 55.3 months （95%CI： 49.0 to 61.5 months）. Different degree of dry mouth and taste change symptoms occurred in most patients after radiotherapy, with vision or hearing loss in a small number of patients and brain damage symptoms in no patients.Conclusion Better clinical effect and lower side reaction are observed in nasal NK/T cell lymphoma patients treated with tomotherapy.