Sakata Koh-ichi, Fuwa Nobukazu, Kodaira Takeshi, Aratani Kazunori, Ikeda Hikaru, Takagi Masaru, Nishio Masamichi, Satoh Masaaki, Nakamura Shigeo, Satoh Hidetoshi, Hareyama Masato
Department of Radiology, Sapporo Medical University, School of Medicine, Japan.
Radiother Oncol. 2006 May;79(2):179-84. doi: 10.1016/j.radonc.2006.03.014. Epub 2006 Apr 27.
This study was conducted to analyze the influence of radiotherapy doses and chemotherapy doses and clinical parameters on in-field disease control in order to assess the optimal radiation doses for treatment of mature T/NK-cell lymphomas according to the newly proposed WHO classification.
Subjects consisted of 62 patients with mature T/NK-cell lymphomas treated with radiotherapy at four Japanese institutions between 1983 and 2002. We reevaluated all histopathological specimens of non-Hodgkin's lymphomas (NHL), using the WHO classification. Radiation therapy was usually delivered to the involved field. The majority of patients also received adriamycin-based chemotherapy such as CHOP, modified CHOP, or more intensive chemotherapy.
There were no significant differences in radiosensitivity among subtypes of mature T/NK-cell lymphomas, at least between extranodal NK/T-cell lymphomas, nasal type and peripheral T-cell lymphomas, unspecified. There was a radiation dose-response in non-bulky mature T/NK-cell lymphomas, indicating that radiation doses of more than 52 Gy may be required to obtain in-field control. However, it was difficult to obtain local control of bulky T-cell lymphomas, even with high doses of irradiation.
Mature T/NK-cell lymphomas were more radioresistant than B-cell lymphomas such as diffuse large B-cell lymphomas (DLBCL). The chemotherapy including adriamycin did not improve the in-field control of mature T/NK-cell lymphomas. These results were obtained by using non-randomized data and the significance of these results is limited by bias in data. However, our results suggest that the treatment strategy which is usually used for DLBCL, that is, a combined modality of CHOP and around 40 Gy of radiotherapy, may not be sufficiently effective for mature T/NK-cell lymphomas.
本研究旨在分析放疗剂量、化疗剂量及临床参数对野内疾病控制的影响，以便根据世界卫生组织（WHO）新提出的分类法评估治疗成熟T/NK细胞淋巴瘤的最佳放疗剂量。
研究对象为1983年至2002年间在日本四家机构接受放疗的62例成熟T/NK细胞淋巴瘤患者。我们使用WHO分类法对所有非霍奇金淋巴瘤（NHL）的组织病理学标本进行了重新评估。放疗通常针对受累野进行。大多数患者还接受了以阿霉素为基础的化疗，如CHOP、改良CHOP或更强的化疗。
成熟T/NK细胞淋巴瘤各亚型之间的放射敏感性无显著差异，至少在结外NK/T细胞淋巴瘤鼻型与未特定的外周T细胞淋巴瘤之间无显著差异。非巨大成熟T/NK细胞淋巴瘤存在放射剂量反应，表明可能需要超过52 Gy的放射剂量才能实现野内控制。然而，即使给予高剂量照射，也难以实现巨大T细胞淋巴瘤的局部控制。
成熟T/NK细胞淋巴瘤比B细胞淋巴瘤如弥漫性大B细胞淋巴瘤（DLBCL）更具放射抗性。含阿霉素的化疗并未改善成熟T/NK细胞淋巴瘤野内控制情况。这些结果是通过使用非随机数据获得的，且这些结果的意义受数据偏差限制。然而，我们的结果表明，通常用于DLBCL的治疗策略，即CHOP联合约40 Gy放疗的综合治疗方式，对成熟T/NK细胞淋巴瘤可能不够有效。
