早期结外鼻型NK/T细胞淋巴瘤同期放化疗疗效分析

目的:探讨Ⅰ E～ⅡE期结外鼻型NK/T细胞淋巴瘤同期放化疗的疗效,并进一步分析其可行性.方法:回顾分析18例早期结外鼻型NK/T细胞淋巴瘤患者,以序贯化放疗50例为对照.18例同期放化疗患者中诱导化疗+同期放化疗+辅助化疗3例,诱导化疗十同期放化疗13例,同期放化疗十辅助化疗1例,单纯同期放化疗1例,全组放疗中位剂量54 Gy.结果:诱导化疗后的总缓解率为50.0％(8/16),治疗结束后为100.0％(18/18).同期放化疗组与对照组的5年总生存率分别为80.8％和54.3％(x2=3.66,P=0.05),5年无进展生存率(PFS)分别为75.8％和43.3％(x2=6.13,P=0.01),5年局部控制(LC)率分别为94.1％和56.7％(x2=6.32,P-0.01).同期放化疗过程中出现Ⅲ～Ⅳ度骨髓抑制率为27.8％(5/18),Ⅲ度口腔黏膜反应率为16.7％(3/18),Ⅲ度咽喉反应率为5.6％(1/18),其余不良反应均 为Ⅰ～Ⅱ度,Ⅲ～Ⅳ反应经对症处理后未影响下一步治疗.结论:同期放化疗是早期结外鼻型NK/T细胞淋巴瘤安全、有效的治疗方法,相对其他接受放疗患者有提高局部控制率和生存时间的趋势,其毒副反应可以耐受.

Preliminary outcome of concurrent chemoradiation therapy in patients with early stage extranodal nasal type NK/T-cell lymphoma

OBJECTIVE: To investigate concurrent chemoradiation therapy(CCRT) in a group of patients with early stage extranodal nasal type NK /T-cell lymphoma;and report the feasibility and preliminary outcome of this treatment.METHODS: Eighteen patients with diagnoses of early stage ENKTCL were treated with CCRT.In treatment,3 patients received induction CT + CCRT + sequential CT,13 patients received induction CT followed by CCRT,1 patients received CCRT and sequential CT,and 1 patients received CCRT alone.For local control(LC) and survival comparisons,50 consecutive patients with early stage ENKTCL and comparable clinical features were analyzed as control group,who received sequential CT and RT during the same period.The median dose was 54 Gy.RESULTS: Overall remission(CR+PR) rate after induction CT and completion of CCRT were 50.0%(8/16) and 100.0%(18/18),respectively.The difference between the 5-years OS rate was significant(80.8% vs 54.3%,χ2=3.66,P=0.05),the 5-years progress-free survival(PFS) rate showed significant improvement than that of the 50 patients treated with sequential CT and RT(75.8% vs 43.3%,χ2=6.13,P=0.01),and the 5-years locally controlled(LC) rate also showed significant improvement than the control group(94.1% vs 56.7%,χ2=6.32,P=0.01).Grade Ⅲ or Ⅳ bone marrow suppression was observed in 5 patients(27.8%).Three patients(16.7%) developed grade Ⅲ oral mucositis.One patient(5.6%) developed grade Ⅲ sore throat,and the remaining adverse events were all grade Ⅰ to Ⅱ.CONCLUSION: This preliminary result demonstrates that CCRT may be an effective treatment improvement for early stage ENKTCL,and its toxicity can be tolerated.