利妥昔单抗时代放疗对早期韦氏环弥漫大B细胞淋巴瘤的作用价值  

Value of radiotherapy for early-stage Waldeyer ’ s ring diffuse large B-cell lymphoma in the rituximab era

作　　者：徐勇刚[1,2] 李晔雄[1] 王维虎[1] 金晶[1] 王淑莲[1] 刘跃平[1] 宋永文[1] 任骅[1] 房辉[1] 刘清峰[1] 吴润叶[1] 亓姝楠[1] 陈波[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院放疗科,100021 [2]北京医院放疗科

出　　处：《中华放射肿瘤学杂志》2015年第5期502-505,共4页Chinese Journal of Radiation Oncology

摘　　要：目的：分析早期韦氏环弥漫大B细胞淋巴瘤接受利妥昔单抗加CHOP为主方案化疗后放疗的作用价值。方法2000—2013年收治83例确诊为原发韦氏环弥漫大B细胞淋巴瘤患者，其中Ⅰ期25例、Ⅱ期58例。全组接受了利妥昔单抗加CHOP为主方案化疗，62例接受了受累野放疗（韦氏环＋颈部淋巴结区域），21例未接受放疗。 Kaplan-Meier法计算OS、PFS、LRC并Logrank法检验和单因素分析，Cox模型多因素分析。结果全组5年样本数18例，5年OS、PFS和LRC率分别为89％、84％和90％。单因素分析显示年龄＞60岁、LDH升高、ECOG≥2分和IPI≥2分是OS的预后不良因素。年龄＞60岁、肿瘤≥5 cm、ECOG≥2分和IPI≥2分是PFS和LRC的影响因素。在利妥昔单抗治疗基础上加入巩固性放疗比未放疗者提高了5年PFS、LRC，分别为94％比58％（ P＝0.003）、100％比61％（ P＝0.000），OS有增加趋势（94％比71％，P＝0.063）。结论早期韦氏环弥漫大B细胞淋巴瘤利妥昔单抗加CHOP为主方化疗后巩固性放疗显著改善了PFS、LRC率，并可能改善OS率，需大样本和前瞻性研究证实。Objective To evaluate the value of radiotherapy following rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone （ R.CHOP ）.based chemotherapy for patients with early.stage Waldeyer’ s ring diffuse large B.cell lymphoma （ WR.DLBCL）. Methods Eighty.three patients diagnosed with early.stage WR.DLBCL who were admitted to our hospital from 2000 to 2013 were enrolled in the study. In these patients, twenty.five had stageⅠdisease and fifty.eight had stageⅡdisease. All patients received R.CHOP.based chemotherapy with （ n= 62 ） or without （ n= 21 ） involved.field radiotherapy （ Waldeyer’ s ring plus cervical lymph nodes ） . The overall survival （ OS ） , progression.free survival （ PFS） , and local.regional control （ LRC） rates were calculated using the Kaplan.Meier method. The univariate analysis was performed using the log.rank method. The multivariate analysis was performed using the Cox regression model. Results In all patients, the 5.year sample size was 18;the 5.year OS, PFS, and LRC rates were 89%, 84%, and 90%, respectively. According to the univariate analysis, patient age greater than 60 years, an increased lactate dehydrogenase level, Eastern Cooperative Oncology Group （ ECOG ） performance status no less than 2, and International Prognostic Index （ IPI ） no less than 2 were poor prognostic factors. Patient age greater than 60 years, a tumor size no less than 5 cm, ECOG performance status no less than 2, and IPI no less than 2 were influencing factors for PFS and LRC rates. In addition to the treatment with rituximab, patients treated with consolidative radiotherapy had significantly higher PFS and LRC rates （94% vs. 58%, P=0.003;100% vs. 61%, P=0.000） as well as slightly higher OS rate （ 9 4%vs . 7 1%, P=0.0 6 3 ） than those treated without radiotherapy . Conclusions Consolidative radiotherapy-amp;nbsp;following R.CHOP.based chemotherapy significantly improves PFS, LRC, and probably OS rates for early.stage WR.DLBCL. This conclusion stil

关 键 词：韦氏环弥漫大B细胞淋巴瘤/放射疗法 韦氏环弥漫大B细胞淋巴瘤/化学疗法 利妥昔单抗 

分 类 号：R733.1[医药卫生—肿瘤]