Radiation dose reduction for patients with extranodal NK/T-cell lymphoma with complete response after initial induction chemotherapy.
Radiation dose reduction for patients with extranodal NK/T-cell lymphoma with complete response after initial induction chemotherapy.
复制标题
初次诱导化疗后完全缓解的结外 NK/T 细胞淋巴瘤患者的放射剂量减少
DOI：
10.2147/ott.s116591
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发表时间：
2016
影响因子：
4
通讯作者：
Zhang YJ
中科院分区：
文献类型：
--
作者：
Wang L;Bi XW;Xia ZJ;Huang HQ;Jiang WQ;Zhang YJ
以往的研究发现，放射治疗（RT）剂量小于50戈伊导致早期结内NK/T细胞淋巴瘤（ENKTL）的预后较差。现在，诱导化疗（CT）后，RT巩固经常使用。对于CT后获得完全缓解（CR）的患者，是否可以安全地减少RT剂量仍是未知数。本回顾性研究比较了CT获得CR后接受高剂量（>50戈伊）和低剂量（≤50戈伊）放疗的患者的生存结局。144例早期ENKTL患者在诱导CT后获得CR并接受RT巩固治疗。31例患者接受了较低剂量的放疗（中位数46戈伊，范围36-50戈伊），113例患者接受了较高剂量的放疗（中位数56戈伊，范围52-66戈伊）。在单变量生存分析中，年龄>60岁、局部肿瘤浸润和非门冬酰胺酶基CT与较差的无进展生存期（PFS）和总生存期（OS）相关。然而，接受较高和较低剂量RT治疗的患者之间的PFS和OS没有差异，这在多变量生存分析中得到证实。此外，减少剂量RT不影响局部控制率。最常见的RT相关副作用是1/2级粘膜炎和皮炎，3级粘膜炎或皮炎的发生率在接受减少剂量RT治疗的患者中较低（粘膜炎为9.7% vs 15.0%，皮炎为6.5% vs 17.7%）。总之，这项研究发现，RT剂量可以安全地减少，而不会影响生存结局，并进一步改善RT相关的副作用。前瞻性随机对照试验是必要的，以验证我们的研究结果。
Previous studies have found that radiotherapy (RT) dose less than 50 Gy resulted in inferior outcomes for early stage extranodal NK/T-cell lymphoma (ENKTL). Nowadays, induction chemotherapy (CT) followed by RT consolidation is often used. For patients who get complete response (CR) after CT, whether RT dose can be safely reduced or not remains unknown. This retrospective study compared the survival outcomes between patients who received higher dose (>50 Gy) and lower dose (≤50 Gy) RT after CR was attained by CT. One hundred and forty four patients of early stage ENKTL got CR after induction CT and received RT consolidation. Thirty-one patients received lower dose RT (median 46 Gy, range, 36–50 Gy), and 113 patients received higher dose RT (median 56 Gy, range, 52–66 Gy). In univariate survival analysis, age >60, local tumor invasion, and non-asparaginase-based CT were associated with inferior progression-free survival (PFS) and overall survival (OS). However, there were no differences in PFS and OS between patients treated with higher and lower dose RT, which was confirmed in the multivariate survival analysis. Furthermore, reduced dose RT did not affect local control rate. Most common RT-related side effects were grade 1/2 mucositis and dermatitis, and the incidence rate of grade 3 mucositis or dermatitis was lower in patients treated with reduced dose RT (9.7% vs 15.0% for mucositis, and 6.5% vs 17.7% for dermatitis). In conclusion, this study found that RT dose could be safely reduced without compromising survival outcomes and further improved RT-related side effects. Prospective randomized controlled trials are warranted to validate our findings.