CAJ | 학술논문

背景与目的:放射治疗是早期鼻腔NK/T细胞淋巴瘤的主要治疗手段.近年来,越来越多的研究表明,在头颈部肿瘤的放射治疗中,调强放射治疗(intensity-modulated radiotherapy,IMRT)较常规放疗具有优势.本研究比较IMRT与常规放疗治疗早期鼻腔NK/T细胞淋巴瘤患者的疗效和急、慢性不良反应.方法:系统分析2005年5月—2011年11月在宁波市李惠利医院行常规放疗以及IMRT的ⅠE~ⅡE期鼻腔NK/T细胞淋巴瘤患者46例,分为IMRT组(14例)和常规放疗组(32例).常规放疗射野靶区包括双侧鼻腔、筛窦、硬腭和同侧上颌窦,颈部淋巴结受侵时加做双颈照射,靶区剂量(50~54)Gy/(25~27)f,2.0 Gy/f;IMRT在CT下勾画靶区,剂量给予54 Gy/27 f,2.0 Gy/f.比较IMRT和常规放疗治疗早期鼻腔NK/T细胞淋巴瘤的疗效和不良反应.结果:IMRT组与常规放疗组的完全缓解率分别为78.6%和68.8%,差异无统计学意义(P>0.05);IMRT组与常规放疗组的3年总生存率(overall survival,OS)分别为71.4%和62.5%,差异无统计学意义(P>0.05).IMRT组的急性不良反应较常规放疗组轻(P<0.05);IMRT组患者晚期损伤中口干程度和味觉改变方面较常规放疗组减轻,而听力及视力损伤、脑损伤发生率等差异无统计学意义(P>0.05).结论:IMRT与常规放疗相比,临床疗效满意,同时能够减轻急性不良反应,降低部分晚期损伤发生率,有望改善患者的生存质量.
배경여목적:방사치료시조기비강NK/T세포림파류적주요치료수단.근년래,월래월다적연구표명,재두경부종류적방사치료중,조강방사치료(intensity-modulated radiotherapy,IMRT)교상규방료구유우세.본연구비교IMRT여상규방료치료조기비강NK/T세포림파류환자적료효화급、만성불량반응.방법:계통분석2005년5월—2011년11월재저파시리혜리의원행상규방료이급IMRT적ⅠE~ⅡE기비강NK/T세포림파류환자46례,분위IMRT조(14례)화상규방료조(32례).상규방료사야파구포괄쌍측비강、사두、경악화동측상합두,경부림파결수침시가주쌍경조사,파구제량(50~54)Gy/(25~27)f,2.0 Gy/f;IMRT재CT하구화파구,제량급여54 Gy/27 f,2.0 Gy/f.비교IMRT화상규방료치료조기비강NK/T세포림파류적료효화불량반응.결과:IMRT조여상규방료조적완전완해솔분별위78.6%화68.8%,차이무통계학의의(P>0.05);IMRT조여상규방료조적3년총생존솔(overall survival,OS)분별위71.4%화62.5%,차이무통계학의의(P>0.05).IMRT조적급성불량반응교상규방료조경(P<0.05);IMRT조환자만기손상중구간정도화미각개변방면교상규방료조감경,이은력급시력손상、뇌손상발생솔등차이무통계학의의(P>0.05).결론:IMRT여상규방료상비,림상료효만의,동시능구감경급성불량반응,강저부분만기손상발생솔,유망개선환자적생존질량.
@@@@Background and purpose: Radiotherapy is the main treatment strategy of early stage nasal natural killer(NK)/T-cell lymphoma. Recently, several studies have shown that intensity-modulated radiotherapy (IMRT) is superior to conventional radiotherapy in the treatment of head and neck cancer. The aim of the present study was to compare the therapeutic efficacy and acute and late adverse toxicities in patients with early stage nasal NK/T-cell lymphoma receiving conventional external beam radiation therapy (CRT) versus IMRT. Methods: Forty-six patients with localized stage ⅠE and ⅡE nasal NK/T-cell lymphoma treated in Lihuili Hospital between May 2005 and Nov. 2011 were systemically reviewed. Of all the patients, 32 patients received conventional radiotherapy (CRT group) and 14 received IMRT (IMRT group). Clinical treatment volume included bilateral nasal cavity, paranasal sinus and bilateral cervical region while cervical lymph node involved, two dimensional fields were applied to the patients in the CRT group with a total dose of 50-54 Gy in 25-27 fractions. Patients in IMRT group received 54 Gy in 27 fractions. Therapeutic efficacy and adverse effects were observed and compared between CRT and IMRT groups. Results: The CR rate of CRT and IMRT groups were 68.8% and 78.6%, respectively(P>0.05),the 3-year-overall survival (OS) of IMRT group was 71.4 %, comparing 62.5 % of CRT group(P>0.05). Statistical difference was not found in either CR rate or survival. The acute reactions like dry mouth, odynophagia, dysphagia, dermatitis and mucositis were observed in CRT and IMRT groups, less severe toxicities were notified in IMRT group with statistically significant difference (P<0.05). Xerostomia and taste alteration were less in IMRT group than those in CRT group, whereas the severity of acoustic/optic impairments and late brain injury were not significantly different in both groups. Conclusion: Treatment outcomes in the IMRT and CRT groups were comparable, while fewer acute reactions and some of late toxicities were observed in the IMRT group, and potential improved quality of life can be achieved in patients with IMRT technique.