调强放疗与常规放疗在早期鼻腔NK/T细胞淋巴瘤患者中的治疗对照  

Comparison of treatment outcome and toxicity in patients with early stage nasal natural killer/T-cell lymphoma receiving conventional external beam radiation therapy versus intensity-modulated radiation therapy

作　　者：郑璐[1] 马学军[2] 王建华[1] 许权[1] 张三典[1] 胡静[1] 

机构地区：[1]宁波市医疗中心李惠利医院放疗科,浙江宁波315040 [2]复旦大学附属肿瘤医院放疗科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2013年第3期229-234,共6页China Oncology

摘　　要：背景与目的：放射治疗是早期鼻腔NK／T细胞淋巴瘤的主要治疗手段。近年来，越来越多的研究表明，在头颈部肿瘤的放射治疗中，调强放射治疗（intensity—modulated radiotherapy，IMRT）较常规放疗具有优势。本研究比较IMRT与常规放疗治疗早期鼻腔NK／T细胞淋巴瘤患者的疗效和急、慢性不良反应。方法：系统分析2005年5月-2011年11月在宁波市李惠利医院行常规放疗以及IMRT的Ⅰε～Ⅱε期鼻腔NK／T细胞淋巴瘤患者46例，分为IMRT组（14例）和常规放疗组（32例）。常规放疗射野靶区包括双侧鼻腔、筛窦、硬腭和同侧上颌窦，颈部淋巴结受侵时加做双颈照射，靶区剂量（50～54）Gy／（25～27）f，2．0Gy／f；IMRT在cT下勾画靶区，剂量给予54Gy／27f，2．0Gy／f。比较IMRT和常规放疗治疗早期鼻腔NK／T细胞淋巴瘤的疗效和不良反应。结果：IMRT组与常规放疗组的完全缓解率分别为78．6％和68．8％，差异无统计学意义（P）O．05）；IMRT组与常规放疗组的3年总生存率（overall survival，OS）分别为71．4％和62．5％，差异无统计学意义（P〉0．05）。IMRT组的急性不良反应较常规放疗组轻（P〈0．05）；IMRT组患者晚期损伤中口干程度和味觉改变方面较常规放疗组减轻，而听力及视力损伤、脑损伤发生率等差异无统计学意义（P〉0．05）。结论：IMRT与常规放疗相比，临床疗效满意，同时能够减轻急性不良反应，降低部分晚期损伤发生率，有望改善患者的生存质量。Background and purpose： Radiotherapy is the main treatment strategy of early stage nasal natural killer（NK）/T-cell lymphoma. Recently, several studies have shown that intensity-modulated radiotherapy （IMRT） is superior to conventional radiotherapy in the treatment of head and neck cancer. The aim of the present study was to compare the therapeutic efficacy and acute and late adverse toxicities in patients with early stage nasal NK/T-cell lymphoma receiving conventional external beam radiation therapy （CRT） versus IMRT. Methods： Forty-six patients with localized stage Ⅰεand Ⅱε nasal NK/T-ceU lymphoma treated in Lihuili Hospital between May 2005 and Nov. 2011 were systemically reviewed. Of all the patients, 32 patients received conventional radiotherapy （CRT group） and 14 received IMRT （IMRT group）. Clinical treatment volume included bilateral nasal cavity, paranasal sinus and bilateral cervical region while cervical lymph node involved, two dimensional fields were applied to the patients in the CRT group with a total dose of 50-54 Gy in 25-27 fractions. Patients in IMRT group received 54 Gy in 27 fractions. Therapeutic efficacy and adverse effects were observed and compared between CRT and IMRT groups. Results： The CR rate of CRT and IMRT groups were 68.8% and 78.6%, respectively（P〉0.05）,the 3-year-overall survival （OS） of IMRT group was 71.4 %, comparing 62.5 % of CRT group（P〉0.05）. Statistical difference was not found in either CRrate or survival. The acute reactions like dry mouth, odynophagia, dysphagia, dermatitis and mucositis were observed in CRT and IMRT groups, less severe toxicities were notified in IMRT group with statistically significant difference （P〈0.05）. Xerostomia and taste alteration were less in IMRT group than those in CRT group, whereas the severity of acoustic/optic impairments and late brain injury were not significantly different in both groups. Conclusion： Treatment outcomes in the IMRT and CRT groups were comparable, while fewer ac

关 键 词：鼻腔NK T细胞淋巴瘤 调强放疗 治疗疗效 不良反应 

分 类 号：R730.55[医药卫生—肿瘤]