High-Dose and Extended-Field Intensity Modulated Radiation Therapy for Early-Stage NK/T-Cell Lymphoma of Waldeyer's Ring: Dosimetric Analysis and Clinical Outcome
High-Dose and Extended-Field Intensity Modulated Radiation Therapy for Early-Stage NK/T-Cell Lymphoma of Waldeyer's Ring: Dosimetric Analysis and Clinical Outcome
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DOI：
10.1016/j.ijrobp.2013.08.040
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发表时间：
2013-12-01
影响因子：
7
通讯作者：
Dai, Jian-Rong
中科院分区：
文献类型：
--
作者：
Bi, Xi-Wen;Li, Ye-Xiong;Dai, Jian-Rong
目的：评价大剂量扩野调强放射治疗(IMRT)治疗早期Waldeyer环NK/T细胞淋巴瘤(WR-NKTCL)的剂量学效益、治疗效果和毒性反应。方法与材料：回顾分析30例早期WR-NKTCL患者接受扩野IMRT治疗的临床资料。原发灶和阳性颈淋巴结(计划靶区需要根治性照射[PTV50])的剂量为50GY，阴性颈淋巴结(PTV40)的剂量为40Gy.评估了靶区和临界正常结构的剂量学参数。采用Kaplan-Meier方法计算局部区域控制(LRC)、总生存期(OS)和无进展生存期(PFS)。结果：PTV50和PTV40的中位剂量分别为53.2GY和43.0GY。只有1.4%的PTV50和0.9%的PTV40获得了低于95%的处方剂量，这表明目标覆盖率很高。左侧和右侧腮腺的平均剂量分别为27.7和28.4Gy.2年OS、PFS和LRC率分别为71.2%、57.4%和87.8%。除吞咽困难和粘膜炎为3级外，大多数急性毒性反应为1-2级。最常见的晚期毒性是1-2级口干症，没有患者出现任何3级晚期毒性。腮腺的平均剂量与晚期口干程度之间存在相关性。结论：调强放疗在WR-NKTCL患者中获得了良好的靶区覆盖和剂量符合性，以及良好的生存率和局部控制率，且毒性可接受。(C)2013年爱思唯尔公司。
Purpose: To assess the dosimetric benefit, treatment outcome, and toxicity of high-dose and extended-field intensity modulated radiation therapy (IMRT) in patients with early-stage NK/T-cell lymphoma of Waldeyer's ring (WR-NKTCL).Methods and Materials: Thirty patients with early-stage WR-NKTCL who received extended-field IMRT were retrospectively reviewed. The prescribed dose was 50 Gy to the primary involved regions and positive cervical lymph nodes (planning target volume requiring radical irradiation [PTV50]) and 40 Gy to the negative cervical nodes (PTV40). Dosimetric parameters for the target volume and critical normal structures were evaluated. Locoregional control (LRC), overall survival (OS), and progression-free survival (PFS) were calculated using the Kaplan-Meier method.Results: The median mean doses to the PTV50 and PTV40 were 53.2 Gy and 43.0 Gy, respectively. Only 1.4% of the PTV50 and 0.9% of the PTV40 received less than 95% of the prescribed dose, indicating excellent target coverage. The average mean doses to the left and right parotid glands were 27.7 and 28.4 Gy, respectively. The 2-year OS, PFS, and LRC rates were 71.2%, 57.4%, and 87.8%. Most acute toxicities were grade 1 to 2, except for grade >= 3 dysphagia and mucositis. The most common late toxicity was grade 1-2 xerostomia, and no patient developed any >= grade 3 late toxicities. A correlation between the mean dose to the parotid glands and the degree of late xerostomia was observed.Conclusions: IMRT achieves excellent target coverage and dose conformity, as well as favorable survival and locoregional control rates with acceptable toxicities in patients with WR-NKTCL. (C) 2013 Elsevier Inc.