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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。
OBJECTIVE: To report the radiotherapy efficacy of 30 patients with primary cutaneous B-cell lymphoma based on the latest WHO / EORTC staging. Materials and Methods: From October 1978 to June 2002, 30 patients with cutaneous B-cell lymphoma underwent skin radiotherapy. 21 males and 9 females. Ages 23-89 (mean age 48 years). Follow-up period from the end of radiotherapy, the average follow-up period of 47 months (4 to 301 months). All patients were re-staged according to WHO / EORTC stage: 2 cases of PCMZL (6.7%), 18 cases of PCFCL (60%), 8 cases of PCLBCL calf (26.7%), 1 case of PCLBCL (3.3% type. According to the number of lesions, the patients were divided into three groups: single group (13 cases) (43%) in the first group, multiple lesions (13%) in the same group ). According to the lesion is divided into: 7 cases of head and neck lesions, 6 cases of trunk lesions, 7 cases of lower extremity lesions, 3 cases of upper limb lesions, 7 cases of systemic diffuse lesions. Eleven patients (36.7%) received neoadjuvant chemotherapy (CHOP) before radiotherapy, with residual lesions during radiotherapy. Nine cases of multiple lesions and diffuse lesions were treated with extended field irradiation (EFI). Treatment machine for the SATURNE CLINAC, 4-8MeV energy electronic line dose of 30Gy (4 times / week; 2.5Gy / times), the treatment target for the whole body or half body. Local field irradiation (LFI) as a radical treatment or extended field treatment of 22 cases, the treatment of DARPAC, 0.55cm aluminum filter, 45KV X-ray irradiation of small lesions, more than 100KV energy for the treatment of deeper Lesions, the use of different types and sizes of light-limiting tube (diameter 1.5-20cm) irradiation of different sizes of lesions. Dose 30-40Gy (2Gy / time, 5 times / week). All radiation field for the normal mass of the surrounding plus 2.5cm. Statistical software for SPSS10.0. Results: The complete remission (CR) was 86% and the complete remission time was 4 to 301 months. Three patients were partially relieved (PR, 11%). 1 case of progress. The 10-year overall survival was 87%. Three patients died (1 PCMBCL, 2 PCLBCL calf 29%). All patients can tolerate radiotherapy. Conclusions: According to WHO / EORTC staging, PCMBCL and PCFCL have high survival rates. PCLBCL lower limb type prognosis is poor. Local wild on the local lesions have a therapeutic effect, and can maintain long-term relief. Patients with diffuse lesions often use extended field and / or chemotherapy. For advanced patients, chemotherapy is the treatment of choice, while using local field therapy to obtain a good palliative effect.