Treatment Outcome Following Three-Dimensional Conformal Radiation Therapy for NK/T-Cell Lymphoma of Nasal Cavity: A Single Institute Survey in Taiwan

鼻腔NK/T細胞淋巴瘤三度空間立體順形放射治療成果：臺灣單一機構研究

10.6316/TRO/200714(3)165

吳思遠(Szu-Yuan Wu)；方富民(Fu-Min Fang)；郭景元(Ching-Yuan Kuo)；王重榮(Chong-Jong Wang)；陳惠君(Hui-Chun Chen)；許軒之(Hsuan-Chih Hsu)；黃郁傑(Yu-Jie Huang)；汪昶佑(Chang-Yu Wang)；黃英彥(Eng-Yen Huang)

三度空間立體順形放射治療 ； NK/T細胞淋巴瘤 ； 鼻腔 ； 整體存活率 ； Three-dimensional conformal radiotherapy ； NK/T-cell lymphoma ； Nasal cavity ； Overall survival

放射治療與腫瘤學

14卷3期（2007 / 09 / 01）

165 - 178

英文

目的：評估鼻腔NK/T細胞淋巴瘤三度空間立體順形放射治療的成果。 材料與方法：自2000年8月至2005年3月，共有11位以病理組織特徵和特殊免疫顯型診斷為鼻腔NK/T細胞淋巴瘤的患者。其中男性5位女性6位，年齡分佈介於27至90歲（中位值為57歲）。有5位病人接受4到6次的CHOP（cyclophosphamide，doxorubicin，vincristine及prednisolone）治療，隨後接受放射治療。另外三位先接受3次的CHOP治療再接受放射治療而後再接受3次的CHOP治療。我們排除了兩位在放射治療過程中死亡的患者。而所有的患者均接受三度空間立體順形放射治療，並根據計畫給予50.4-54.0Gy/28-30次。 結果：中位數追蹤期為24.9個月（範圍介於4至75個月），其中9位患者中有7人(78%)達到完全緩解。而整體2年的存活率為79%。有兩位患者在治療完成的一年內死亡。兩年的局部控制率和無遠端轉移率分別是89%和79%。在單變數分析中會有不良預後的臨床因子如下：較高的Ann Arbor分期(p=0.005)，B型症狀的表現(p=0.005)，和較高的International Prognostic Index (IPI)分數(p=0.005)。在8位第一期的患者中，7位（88%）達到腫瘤完全緩解，整體2年存活率為88%。由三度空間立體順形放射治療造成的副作用是暫時性且可接受的。 結論：在我們的經驗中發現，三度空間立體順形放射治療針對鼻腔NK/T細胞淋巴瘤患者的治療策略是：使用大於50Gy的放射劑量，包覆可見的腫瘤/腫瘤術後的區域加上適當的範圍，這樣的治療方式是合理的。

Purpose: To evaluate the treatment outcome following three-dimensional conformal radiotherapy (3D-CRT) for NK/T-cell lymphoma of nasal cavity. Materials and Methods: Between August 2000 and March 2005, 11 patients had NK/T-cell lymphomas of nasal cavity diagnosed by histopathologic characteristics and typical immunophenotype. There were 5 males and 6 females, patients with age ranged from 27 years to 90 years (median, 57 years). Five patients were scheduled to receive 4-6 cycles of CHOP (cyclophosphamide, doxorubicin, vincrinstine and prednisolone) followed by radiotherapy. Three patients received 3 cycles of neo-adjuvant CHOP, radiotherapy, and 3 cycles of CHOP adjuvant. We excluded two patients who were dead during our radiotherapy course. All patients received 3D-CRT. The planned 3D-CRT dose was 50.4-54.0 Gy / 28-30 fractions. Results: The median time of follow-up was 24.9 months (range 4 to 75 months). Seven (78%) of nine patients achieved complete remission (CR). The 2-year overall survival (OS) rate was 79%. Two patients expired in the first year. The 2-year local control and distant metastasis-free rates were 89% and 79%, respectively. The clinical factors predicting worse survival in univariate analysis were as follows: advanced Ann Arbor stage (p=0.005), B symptom (p=0.005), and higher International Prognostic Index scores (p=0.005). In the stage IE group, 7 of 8 patients (88%) achieved CR. The 2-year OS rate was 88%. The side effects of 3D-CRT were temporary and acceptable. Conclusion: In our experience, the treatment policy for NK/T cell lymphoma of nasal cavity using 3D-CRT with greater than 50 Gy to gross tumor/tumor bed plus adequate margin was feasible.