皮肤B细胞淋巴瘤的放射治疗

目的:根据WHO/EORTC最新分期,报告30例原发性皮肤B细胞淋巴瘤患者的放疗效果。材料和方法:从1978年10月到2002年6月,30例皮肤B细胞淋巴瘤患者接受皮肤放射治疗。男性21例,女性9例。年龄23-89岁(平均年龄48岁)。随访期从放疗结束开始计算,平均随访期限47个月(4～301个月)。所有患者根据WHO/EORTC分期重新分期:2例PCMZL(6.7%);18例PCFCL(60%);8例PCLBCL小腿型(26.7%);1例血管内PCLBCL(3.3%);1例未分型。根据病灶数量患者分为:第一组,单个病灶13例(43%);第二组,同一解剖部位的多个病灶13例(43%);第三组,弥散性病灶4例(13%)。根据病灶部位分为:7例头颈部病灶,6例躯干病灶,7例下肢病灶,3例上肢病灶,7例全身弥散病灶。11例(36.7%)在放疗前接受了新辅助化疗CHOP,在放疗时均有残留病灶。选择扩展野(extended field irradiation,EFI)放射治疗9例多发病灶和弥散病灶。治疗机为SATURNE CLINAC,能量4-8MeV电子线,剂量为30Gy(4次/周;2.5Gy/次),治疗靶区为全身或半身。局部野(localized field irradiation,LFI)作为根治治疗或扩展野后加量治疗22例,治疗机为DARPAC,0.55cm铝过滤片,45KV的X线照射小病灶,100KV以上能量的用于治疗较深部病灶,运用不同类型及大小的限光筒(直径1.5-20cm)照射不同大小的病灶。剂量30-40Gy(2Gy/次,5次/周)。所有放射野为肿块加周围正常皮肤2.5cm。统计软件为SPSS10.0。结果:完全缓解(CR)为86%,完全缓解时间4～301个月。3例患者部分缓解(PR,11%)。1例进展。患者10年总生存率为87%。3例患者死亡(1例PCMBCL,2例PCLBCL小腿型29%)。所有患者都能耐受放疗。结论:根据WHO/EORTC分期,PCMBCL和PCFCL生存率高。PCLBCL下肢型预后较差。局部野对局部病灶有治疗效果,并能保持长期缓解。弥散病灶患者通常采用扩展野和/或化疗。对于进展期的患者,化疗是治疗选择,同时使用局部野治疗获得良好的姑息疗效。

The clinical pathologic analysis of radiotherapy for cutaneous B-cell lymphoma

OBJECTIVE To report results of radiation therapy treatment of 30 B-cell lymphoma patients with an initial cutaneous presentation according to the new classification by the WHO/EORTC. METHODS Thirty patients with cutaneous B-cell lymphoma(CBCL)were treated by cutaneous irradiation based on the number and location of the le- sions and the stage of their tumor.Treatment was conducted using a Saturne Clinac. RESULTS A complete response(CR)from the treatment for our series was 86%.The length of complete remission ranged from 4 to 301 months. Three patients(11%)developed a partial response(PR).One patient was progressive.Disease-free survival(DFS)at 10 years was 87%.Three patiens died[One PCMZL two PCLBCL leg type(29%)].Radiotherapy was generally well tolerated. CONCLUSION According to the WHO/EORTC classification,the survivor results were good for PCMZL and PCFCL.The PCLBCL leg type had a poor prognosis.Localized field irradiation is an effective treatment for some local- ized forms of primary cutaneous B-cell lymphoma,and this mode of therapy can produce prolonged remissions.The patients with wide-spread skin involvement are usually candidates for extended field irradiation and/or che- motherapy.For advanced stages of cutaneous B-cell lymphoma,where che- motherapy is the treatment of choice,a degree of palliation can be achieved using local field irradation.