IMRT早期韦氏环DLBCL的长期观察

Long-term follow-up of patients with early-stage diffuse large B-cell lymphoma of Waldeyer＇ s ring treated with intensity-modulated radiotherapy

目的 研究IMRT对原发于韦氏环早期DLBCL的疗效、预后、放射剂量及不良反应。 方法 收集2008—2015年Ⅰ、Ⅱ期韦氏环DLBCL病例 80例,放化疗为主,3例单纯放疗。化疗后CR 24例,PR 53例。原发灶及颈部淋巴结引流区IMRT。采用Kaplan-Meier法计算生存率,Cox模型预后因素分析,不良反应分级使用RTOG标准。 结果 中位随访时间为64个月,5年LRC、OS、PFS率分别为94%、88%、84%。DVH显示PGTV最高、平均和最低剂量分别为54.47、52.27、38.83 Gy。因素分析显示年龄〉60岁、LDH升高为OS影响因素（P=0.009、0.002）,年龄〉60岁、IPI≥2分及LDH升高为PFS影响因素（P=0.001、0.035、0.007）。全组急性口腔黏膜反应1级 12例、2级 53例、3级 8例,晚期不良反应口干1级 16例、2级 13例。 结论 应用IMRT技术治疗原发韦氏环的早期DLBCL,获得了较理想的LRC、PFS、OS率,同时不良反应可耐受。

Objective To evaluate the treatment outcome, prognostic factors, radiation dose, and toxicities in patients with early-stage primary diffuse large B-cell lymphoma of Waldeyer’s ring （WR-DLBCL） treated with intensity-modulated radiotherapy （IMRT）. Methods This study included 80 patients with a confirmed diagnosis of stage Ⅰ—Ⅱ primary WR-DLBCL who were admitted to our hospital from 2008 to 2015. Only 3 patients received radiotherapy alone, and the other patients received radiotherapy and chemotherapy. After chemotherapy, 24 patients achieved complete remission （CR）, and 53 patients achieved partial remission （PR）. IMRT was given to the primary lesion and cervical lymphatic drainage region. Survival analysis was performed using the Kaplan-Meier method and log-rank test. The Cox model was used for analysis of prognostic factors. The toxicities were scored using the RTOG criteria. Results The median follow-up was 64 months. The 5-year locoregional control （LRC）, overall survival （OS）, and progression-free survival （PFS） rates were 94%, 88%, and 84%, respectively. The dose-volume histogram showed that the maximum, mean, and minimum doses to primary gross tumor volume were 54.47 Gy, 52.27 Gy, and 38.83 Gy, respectively. Prognostic analysis showed that age〉60 years and increased lactate dehydrogenase （LDH） were influencing factors for OS （P=0.009 and 0.002）, and that aged〉60 years, IPI ≥2, and increased LDH were influencing factors for PFS （P=0.001, 0.035, and 0.007）. Among all patients, 12, 53, and 8 experienced grade 1-3 radiation-induced acute oral mucositis, respectively, and 16 and 13 experienced grade 1 and 2 xerostomia as the late toxicity, respectively. Conclusions For patients with early-stage primary WR-DLBCL, IMRT results in satisfactory OS, PFS, and LRC and has tolerable early or late radiation-induced toxicities.