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目的研究鼻腔NK/T细胞淋巴瘤螺旋断层放射治疗后的临床疗效及不良反应。方法对2008年8月-2013年4月我科收治的25例鼻腔NK/T细胞淋巴瘤患者进行螺旋断层放射治疗,该组中3例未行化疗,1例行同步放化疗,2例放疗后行序贯化疗,其余患者均行1~2周期诱导化疗后行放疗再行序贯化疗。所有患者的化疗方案均以CHOP-L方案(环磷酰胺+多柔比星+长春新碱+泼尼松+左旋门冬酰胺酶)为主,化疗总周期数均为1~7次,中位化疗周期数为4次。放疗均采用螺旋断层放射治疗,剂量GTV DT 50~56 Gy(中位剂量50 Gy),单次剂量2~2.78 Gy,CTV剂量范围DT 36~50 Gy(中位剂量40 Gy),单次剂量1.6~2 Gy。结果 25例放疗后达到完全缓解(complete remission,CR)14例,部分缓解(partial response,PR)4例,稳定(stable disease,SD)3例;2例失访,2例放疗后1个月内死亡。患者总有效率(CR+PR)为78.3%,2年总生存率为92%,平均生存期55.3个月(95%置信区间49.0~61.5个月)。放疗后大部分患者出现不同程度的口干及味觉改变症状,少部分出现视力或听力下降,未出现脑损伤症状。结论相对于常规调强放射治疗,鼻腔NK/T细胞淋巴瘤螺旋断层放射治疗的临床疗效更优,不良反应更少。
Objective To study the clinical efficacy and adverse reactions of nasal NK / T cell lymphoma after spiral CT. Methods Twenty-five patients with nasal NK / T cell lymphoma treated in our department from August 2008 to April 2013 were treated with helical tomotherapy. Three patients in this group were treated with concurrent chemoradiotherapy and two with radiotherapy Followed by sequential chemotherapy, the remaining patients were treated with 1 ~ 2 cycles of chemotherapy after radiotherapy followed by sequential chemotherapy. The chemotherapy regimens of all patients were mainly CHOP-L regimen (cyclophosphamide + doxorubicin + vincristine + prednisone + L-asparaginase), with the total number of cycles of chemotherapy being 1 to 7 times The number of chemotherapy cycles is 4 times. Radiotherapy was performed with helical tomotherapy with a dose of GTV DT of 50-56 Gy (median dose of 50 Gy), single dose of 2-2.78 Gy, CTV dose of DT 36-50 Gy (median dose of 40 Gy), single dose 1.6 ~ 2 Gy. Results Of the 25 cases, 14 cases achieved complete remission (CR), 4 cases partial response (PR), 3 cases stable disease (SD), 2 cases lost to follow-up and 2 cases received radiotherapy after 1 month Death inside. The total effective rate (CR + PR) was 78.3%. The 2-year overall survival rate was 92%. The mean survival time was 55.3 months (95% confidence interval 49.0-61.5 months). After radiotherapy, most patients showed varying degrees of symptoms of dry mouth and taste changes, a small part of the visual acuity or hearing loss, no brain injury symptoms. Conclusion Compared with conventional intensity-modulated radiation therapy, nasal NK / T-cell lymphoma with spiral CT is more effective and has fewer side effects.