Kamath S S, Marcus R B, Lynch J W, Mendenhall N P
Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, USA.
Int J Radiat Oncol Biol Phys. 1999 Jun 1;44(3):563-8. doi: 10.1016/s0360-3016(99)00051-6.
PURPOSE/OBJECTIVE: To assess local (in-field) disease control, identify potential prognostic factors, and elucidate the optimal radiotherapy dose in various clinical settings of Stage I and II non-Hodgkin's lymphoma (non-CNS).
MATERIALS & METHODS: A total of 285 consecutive patients with Stage I and II non-Hodgkin's lymphoma were treated with curative intent, including 159 with radiotherapy (RT) alone and 126 with combined-modality therapy (CMT). Of these, 72 patients had low-grade lymphomas (LGL), 92 had intermediate or high-grade lymphomas (I/HGL), and 21 had unclassified lymphomas. Clinical and treatment variables with potential prognostic significance for in-field disease control, freedom from relapse (FFR), and absolute survival (AS) were evaluated by univariate and multivariate analyses.
The 5-, 10-, and 20-year actuarial AS rates were 73%, 46%, and 33% for patients with LGL and 64%, 44%, and 18% for patients with I/HGL, respectively. The 5-, 10-, and 20-year actuarial FFR rates were 62%, 59%, and 49% for patients with LGL and 66%, 57%, and 57% for patients with I/HGL, respectively. Significant prognostic factors identified by the multivariate analysis were age, tumor size, and histology for AS; tumor size and treatment for FFR; and only tumor size for in-field disease control. There were 95 total failures, with only 12 occurring infield. Most failures (65%) were in contiguous unirradiated sites. All 4 in-field failures in patients with LGL occurred after RT doses < 30 Gy, although none occurred in 10 patients with small-volume LGL of the orbit treated with doses < 30 Gy. The 8 in-field failures in patients with I/HGL were distributed evenly throughout the RT dose range; 5 occurred in patients treated with CMT, all with tumors > 6 cm, and 4 with less than a complete response (CR) to chemotherapy.
Our analysis suggests that the overwhelming problem in the treatment of non-Hodgkin's lymphoma is not in-field failure but, rather, failure in contiguous unirradiated sites. A dose of 20-25 Gy may be sufficient for small-volume LGL of the orbit. A dose of 30 Gy is sufficient for LGL in general, as well as for patients with nonbulky (< or = 6 cm) I/HGL treated with CMT who have a CR. However, patients with I/HGL treated with CMT for tumors > 6 cm and/or without a CR may benefit from doses > or = 40 Gy.
目的/目标：评估局部（野内）疾病控制情况，确定潜在的预后因素，并阐明Ⅰ期和Ⅱ期非霍奇金淋巴瘤（非中枢神经系统）在各种临床情况下的最佳放疗剂量。
共有285例Ⅰ期和Ⅱ期非霍奇金淋巴瘤患者接受了根治性治疗，其中159例仅接受放疗（RT），126例接受综合治疗（CMT）。其中，72例为低度淋巴瘤（LGL），92例为中度或高度淋巴瘤（I/HGL），21例为未分类淋巴瘤。通过单因素和多因素分析评估对野内疾病控制、无复发生存（FFR）和绝对生存（AS）具有潜在预后意义的临床和治疗变量。
LGL患者的5年、10年和20年精算AS率分别为73%、46%和33%，I/HGL患者分别为64%、44%和18%。LGL患者的5年、10年和20年精算FFR率分别为62%、59%和49%，I/HGL患者分别为66%、57%和57%。多因素分析确定的显著预后因素，对于AS是年龄、肿瘤大小和组织学；对于FFR是肿瘤大小和治疗方式；对于野内疾病控制仅为肿瘤大小。总共有95例失败，其中仅12例发生在野内。大多数失败（65%）发生在相邻未照射部位。LGL患者的4例野内失败均发生在放疗剂量<30 Gy后，不过10例眼眶小体积LGL患者接受<30 Gy剂量治疗时无失败发生。I/HGL患者的8例野内失败在整个放疗剂量范围内分布均匀；5例发生在接受CMT治疗的患者中，均为肿瘤>6 cm，4例对化疗未达到完全缓解（CR）。
我们的分析表明，非霍奇金淋巴瘤治疗中的主要问题不是野内失败，而是相邻未照射部位的失败。20 - 25 Gy的剂量可能足以治疗眼眶小体积LGL。一般来说，30 Gy的剂量对LGL足够，对于接受CMT治疗且肿瘤非大块（≤6 cm）且达到CR的I/HGL患者也足够。然而，接受CMT治疗的肿瘤>6 cm和/或未达到CR的I/HGL患者可能从≥40 Gy的剂量中获益。
