【作者】 毕锡文；

【导师】 李晔雄；

【作者基本信息】 北京协和医学院 ， 临床医学， 2013， 博士

【摘要】 目的：评价早期原发韦氏环NK/T细胞淋巴瘤(Natural killer/T-cell lymphoma, NKTCL)接受调强放疗的靶区涵盖度、正常组织照射剂量、治疗毒性反应和预后。方法与材料：2005年3月至2012年8月,30例早期原发韦氏环NKTCL接受以根治性调强放疗为主的综合治疗,其中Ann Arbor分期Ⅰ期16例,Ⅱ期14例。53%的患者有鼻腔受侵,70%有B组症状。靶区勾画遵循扩大野原则,根治剂量50Gy,颈部预防照射剂量40Gy。分析剂量-体积直方图评价靶区和危及器官剂量学参数。Kaplan-Meier方法计算总生存率(OS)、无进展生存率(PFS)和局部区域控制率(LRC)。结果：根治性放疗区(PTVso)和预防性治疗区(PTV40)的中位平均剂量分别为53.2和43.0Gy。接受<95%处方剂量的PTVso和PTV40百分比分别为1.4%和0.9%。PTVso的适形指数中位值为0.85。全组的2年OS、PFS和LRC分别为71.2%、57.4%和87.8%。鼻腔受侵和未受侵者的2年OS分别为54%和93%(P=0.017),2年PFS分别为44%和75%(P=0.023)。失败模式以远处淋巴结和/或结外脏器转移为主(11/13例,84.6%)。共有14例患者(46.7%)发生1-2级急性毒性反应,16例(53.3%)发生3-4级急性毒性反应,其中有26.7%和33.3%的患者分别发生≥3级急性吞咽困难和3级急性黏膜炎。晚期毒性反应以口干(1、2级发生率分别为68.2%和27.3%)最常见,发生2级晚期口干的患者双侧腮腺中位平均剂量显著高于0、1级晚期口干患者(31.4Gy vs.25.7Gy, P=0.018)。结论：早期原发韦氏环NKTCL患者接受IMRT可实现良好的靶区覆盖和适形度,并取得良好的局部控制率和总生存率。毒性反应可耐受,腮腺照射剂量与晚期口干严重程度相关。更多还原

【Abstract】 Purpose:To assess the target coverage, normal tissue sparing, toxicity, and treatment outcome of high-dose extended-field intensity-modulated radiotherapy (IMRT) in patients with early-stage NK/T-cell lymphoma (NKTCL) of Waldeyer ring.Methods and Materials:Between March2005and August2012,30patients with early-stage NKTCL of Waldeyer ring received curative IMRT with or without chemotherapy. All patients had Ann Arbor stage Ⅰ (16,53%) or Ⅱ (14,47%) disease.53%of patients had nasal invasion and70%presented with B symptoms. Target volume was contoured following the extended-field approach. The curative dose was50Gy, and the prophylactic dose was40Gy for the cervical and supraclavicular lymph nodes. The dose-volume histograms of the target volume and critical normal structures were evaluated in all patients. The overall survival (OS), progression-free survival (PFS), and locoregional control (LRC) were calculated using the Kaplan-Meier method.Results:The median average dose to the PTV50and PTV40were53.2Gy and43.0Gy, respectively. The percentage of PTV50and PTV40receiving less than95%of the prescribed dose were1.4%and0.9%, respectively. The median conformity index of PTV50was0.85. The2-year OS, PFS and LRC in the whole group were71.2%,57.4%, and87.8%, respectively. The2-year OS and PFS were54%and44%for patients with nasal invasion, and93%and75%for patients without (P=0.017for OS; P=0.023for PFS). Distant nodal and/or extranodal metastasis was the primary pattern of failure (11of13patients,84.6%). Fourteen (46.7%) patients had grade1-2acute toxicities and16patients (53.3%) had grade3-4acute toxicities.23.3%and33.3%of patients had grade>3acute dysphagia and grade3acute mucositis, respectively. Grade1and grade2late xerostomia were the most common late toxicities, observed in15(68%) and6(27%) patients, respectively. The mean dose to the parotid glands was significantly higher in patients with grade2late xerostomia than in patients with grade0-1late xerostomia (31.4Gy vs.25.7Gy,P=0.018).Conclusions:In patients with early-stage NK/T-cell lymphoma of Waldeyer ring, IMRT achieved excellent target coverage and conformity, as well as favorable overall survival and local control. Treatment-related toxicities were acceptable. The severity of late xerostomia was associated with the mean dose to the parotid glands.更多还原