李晔雄 鼻腔NK、T淋巴瘤治疗.docxVIP

BACKGROUND: This study aimed to evaluate the failure patterns and clinical implications in patients with early stage nasal natural killer (NK)/T-cell lymphoma treated with primary radiotherapy.本研究意在评估早期鼻腔NK/T的初治放疗的治疗失败及临床预后因素。METHODS: Two-hundred fourteen patients were included. There were 182 cases of stage I and 32 cases of stage II disease. Patients received radiotherapy alone (n = 96) or radiotherapy and chemotherapy (n = 118). The median dose was 50 grays, and most patients received doxorubicin-based chemotherapy. 一共有214例患者入组。其中I期的患者182例，II期的患者32例。患者接受单纯放疗（N=96）例，放疗化疗118例。放疗中位数为50Gy,大多数患者接受阿霉素为主的化疗。RESULTS: The 5-year overall survival (OS) and progression-free survival rates for all patients were 72% and 65%, respectively. Sixty-three patients experienced treatment failure. The 5-year cumulative in cidences of locoregional, systemic, and overall failures were 12.0%, 25.5%, and 32.9%, respectively. Stage and paranasal extension were significant predictors for systemic failure. The 5-year cumulative incidence of systemic failure was 22.6% for stage I disease versus 42.7% for stage II disease (P .001), and 16.9% for limited disease versus 30.4% for paranasal extension (P .001), respectively. Adding chemotherapy to extended involved-field radiotherapy did not significantly decrease the systemic failure rate nor improve survival. The cumulative incidence of systemic failure and OS rate at 5 years were 24.1% and 74.4% for combined modality therapy compared with 28.5% (P ? 0.758) and 69.8% (P ? 0.529) for radiotherapy alone. A very low incidence of cervical lymph node or central nervous system relapse was observed. 5年总生存（OS）和无进展生存率分别为72％和65％，经历63个病人治疗失败。局部治疗失败，系统治疗失败及整体治疗失败的5年累计发生率分别为12.0％，25.5％和32.9％。分期和鼻旁间隙累及是系统治疗失败的主要预后因素。对于I期的患者5年累计治疗失败发生率为22.6％，相比II期为42.7％（P 0.001）鼻窦侵袭为16.9％与仅局限与鼻腔内比较30.4％（P 0.001）。对与侵袭鼻窦的患者加入放疗前的辅助化疗没有明显降低全身治疗失败及改善生存期。多种方式联合治疗的系统失败率和5年总体生存率分别为24.1％和74.4％与仅行放射治疗的患者相比为28.5％（P=0.758）和69.8％（P=0.529）。颈淋巴结或中枢神经系统复发几率非常低。CONCLUSIONS: Patients with ea