局限性结外黏膜相关淋巴组织淋巴瘤采用放疗的长期疗效。
Long-term outcome in localized extranodal mucosa-associated lymphoid tissue lymphomas treated with radiotherapy.
机构信息
Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
出版信息
Cancer. 2010 Aug 15;116(16):3815-24. doi: 10.1002/cncr.25226.
BACKGROUND
This study was conducted to evaluate the long-term outcomes in patients with stage IE and IIE mucosa-associated lymphoid tissue (MALT) lymphomas treated with involved field radiotherapy (RT).
METHODS
Between 1989 and 2004, 192 patients with stage I and II MALT lymphomas were treated. The report focuses on 167 patients who received RT. The median age of patients was 58 years with a female predominance (2:1). Presenting sites were as follows: orbital adnexa in 71 patients, salivary glands in 28 patients, stomach in 25 patients, thyroid in 21 patients, and other sites in 22 patients. The median dose to nonorbital sites was 30 grays (Gy) (range, 17.5-35 Gy) and was 25 Gy for the orbit (range, 25-35 Gy). The median follow-up was 7.4 years (range, 0.67-16.20 years).
RESULTS
Complete response and complete response, unconfirmed (CR/CRu) was noted in 166 (99%) patients. The 10-year recurrence-free rate (RFR) was 76%, the disease-free survival (DFS) rate was 68%, the overall survival (OS) rate was 87%, and the cause-specific survival rate was 98%. According to presenting site, the 10-year RFR was 95% for thyroid, 92% for stomach, 68% for salivary glands, and 67% for orbit. Patients with thyroid and gastric MALTs had better outcome compared with patients with MALTs diagnosed at other sites (P=.004). Among those patients who achieved CR, 19% developed disease recurrence (n=31), chiefly in distant sites or untreated contralateral-paired organs. At the time of disease recurrence, 7 patients (23%) had transformed to diffuse large B-cell lymphoma, 2 of whom died of lymphoma. The 5-year OS rate after treatment failure was 83%.
CONCLUSIONS
Patients with localized MALT lymphomas are reported to have excellent clinical outcome after moderate-dose RT, and some are likely cured. In the current study, thyroid and gastric MALTs were found to have significantly less risk of distant recurrence. Despite disease recurrence, the overall survival remains excellent in these patients.
背景
本研究旨在评估接受累及野放疗（RT）治疗的 I 期和 II 期黏膜相关淋巴组织（MALT）淋巴瘤患者的长期结果。
方法
1989 年至 2004 年间，共收治了 192 例 I 期和 II 期 MALT 淋巴瘤患者。本报告重点介绍了 167 例接受 RT 治疗的患者。患者中位年龄为 58 岁，女性居多（2:1）。首发部位如下：眼眶附属器 71 例，唾液腺 28 例，胃 25 例，甲状腺 21 例，其他部位 22 例。非眼眶部位的中位剂量为 30 戈瑞（Gy）（范围 17.5-35 Gy），眼眶部位为 25 Gy（范围 25-35 Gy）。中位随访时间为 7.4 年（范围 0.67-16.20 年）。
结果
166 例（99%）患者达到完全缓解和未确认的完全缓解（CR/CRu）。10 年无复发生存率（RFR）为 76%，无疾病生存率（DFS）为 68%，总生存率（OS）为 87%，特异性生存率为 98%。根据首发部位，甲状腺 MALT 的 10 年 RFR 为 95%，胃 MALT 为 92%，唾液腺 MALT 为 68%，眼眶 MALT 为 67%。与其他部位诊断的 MALT 患者相比，甲状腺和胃 MALT 患者的预后更好（P=.004）。在达到 CR 的患者中，19%（n=31）发生疾病复发，主要发生在远处部位或未治疗的对侧配对器官。疾病复发时，7 例（23%）患者转化为弥漫性大 B 细胞淋巴瘤，其中 2 例死于淋巴瘤。治疗失败后 5 年 OS 率为 83%。
结论
报道称，接受中剂量 RT 治疗的局限性 MALT 淋巴瘤患者具有良好的临床结局，部分患者可能被治愈。在本研究中，甲状腺和胃 MALT 远处复发的风险明显较低。尽管疾病复发，但这些患者的总生存率仍然很高。
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