Martens Chandra, Hodgson David C, Wells Woodrow A, Sun Alex, Bezjak Andrea, Pintilie Melania, Crump Michael, Gospodarowicz Mary K, Tsang Richard
Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada.
Int J Radiat Oncol Biol Phys. 2006 Mar 15;64(4):1183-7. doi: 10.1016/j.ijrobp.2005.09.030. Epub 2006 Jan 10.
Patients with chemotherapy-resistant lymphoma have rapidly progressive disease and a poor prognosis. Local symptoms are treated with radiotherapy (RT) for local control. We have reviewed local control and toxicity in patients treated with hyperfractionated accelerated RT.
A total of 34 patients received hyperfractionated RT between 1997 and 2003. The radiation dose was 39.9-40.5 Gy in 30 fractions. The median treatment time was 22 days with twice-daily involved-field RT. The median follow-up was 4.4 years. Response was assessed <3 months after RT and was classified as a complete response, a complete response-unconfirmed, a partial response, or no response. Local control was defined as maintenance of local complete response, complete response-unconfirmed, or lack of local progression with a partial response. Recurrence or progression outside the RT volume was regarded as distant disease.
The median age was 53 years; 20 patients were men and 14 were women. The initial diagnosis was Stage I-II in 56% and Stage III-IV in 44%. The disease bulk was > or =10 cm in 35% (n = 12). The histologic features at diagnosis were follicular in 11 (Grade 1 in 4, Grade 2 in 3, and Grade 3 in 4), diffuse large B-cell in 14, peripheral T-cell lymphoma in 2, Burkitt-like in 1, mantle cell in 2, natural killer cell in 2, plasmacytoma/lymphoma in 1, and T-cell lymphoblastic in 1. The initial treatment was chemotherapy in 32 patients (94%); 71% were refractory to initial chemotherapy and 29% developed a relapse after an initial response. The RT response was complete in 24% (n = 8), complete, unconfirmed in 26% (n = 9), partial in 47% (n = 16), and none in 3% (n = 1). The local control rate was 73% at 1, 2, and 3 years. Grade 1 dermatitis was the most common side effect.
Hyperfractionated RT provided good local control and was well tolerated. This encouraging result requires additional study with comparison to conventional fractionation regimens.
化疗耐药的淋巴瘤患者疾病进展迅速，预后较差。局部症状采用放射治疗（RT）以实现局部控制。我们回顾了接受超分割加速放疗患者的局部控制情况及毒性反应。
1997年至2003年间，共有34例患者接受了超分割放疗。放射剂量为39.9 - 40.5 Gy，分30次给予。中位治疗时间为22天，采用每日两次累及野放疗。中位随访时间为4.4年。放疗后<3个月评估反应，分为完全缓解、完全缓解未确认、部分缓解或无反应。局部控制定义为维持局部完全缓解、完全缓解未确认或部分缓解且无局部进展。放疗野以外的复发或进展视为远处疾病。
中位年龄为53岁；男性20例，女性14例。初始诊断为I - II期的占56%，III - IV期的占44%。肿瘤体积≥10 cm的占35%（n = 12）。诊断时的组织学特征为滤泡性的11例（1级4例，2级3例，3级4例），弥漫大B细胞性的14例，外周T细胞淋巴瘤2例，伯基特样1例，套细胞2例，自然杀伤细胞2例，浆细胞瘤/淋巴瘤1例，T细胞淋巴母细胞性1例。32例患者（94%）初始治疗为化疗；71%对初始化疗耐药，29%在初始缓解后复发。放疗反应为完全缓解的占24%（n = 8），完全缓解未确认的占26%（n = 9），部分缓解的占47%（n = 16），无反应的占3%（n = 1）。1年、2年和3年的局部控制率为73%。1级皮炎是最常见的副作用。
超分割放疗提供了良好的局部控制，且耐受性良好。这一令人鼓舞的结果需要与传统分割方案进行比较的进一步研究。
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