Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Strahlenther Onkol. 2012 Jun;188(6):464-70. doi: 10.1007/s00066-011-0057-0. Epub 2012 Feb 16.
The goal of this work was to analyze the response rate and outcome of patients with stage I-III follicular lymphoma (FL) treated with radiotherapy (RT) alone.
The records of 50 consecutive patients with stage I-III FL treated with RT alone at our department from 1988-2009 were analyzed. The median age was 60 years (range 32-80 years) with a median follow-up duration of 8 years (range 4-11 years). Clinical staging was performed according to the Ann Arbor system. Stage I: 30 patients (60%), stage II: 15 patients (30%), stage III: 5 patients (10%). Thirty-two patients (64%) presented with nodal disease, 14 patients (28%) presented with disease in extranodal sites, and 4 patients (8%) had nodal and extranodal involvement. The RT field encompassed only the involved Ann Arbor nodal regions (involved-field RT) in 26 patients (52%), mantle and whole abdominopelvic fields in 6 patients (12%), mantle field in 10 patients (20%), whole abdominopelvic fields in 5 patients (10%), and a so-called mini-mantle in 3 patients (6%). The total RT dose ranged from 26-56 Gy (median 40 Gy) in daily fractions of 1.2-2.5 Gy.
Complete remission (CR) and partial remission (PR) were observed in 39 (76%) and 9 (20%) patients, respectively. Only 2 of 8 patients (25%) with tumor bulk > 5 cm reached CR, whereas 37 of 42 patients (88%) with a maximum lymphoma diameter < 5 cm achieved CR (p = 0.0001). The median overall survival (OS) and median event-free survival (EFS) were 18 years (CI 95% 10-26 years) and 7 years (6-8 years), respectively. The 2-, 5-, and 10-year OS were 96 ± 3%, 90 ± 5%, and 70 ± 9%, respectively. The 2-, 5-, and 10-year EFS were 90 ± 5%, 70 ± 7%, and 38 ± 9%, respectively. Fifteen patients developed a recurrence outside the radiation field (30%) and 4 patients developed an in-field recurrence (8%). All in-field recurrences were observed in regions without clinical (macroscopic) involvement, which were irradiated with a dose of ≤ 26 Gy. Pretreatment maximum lymphoma diameter < 5 cm (p = 0.039) and complete remission after RT (p = 0.021) were significantly associated with a better OS in the univariate analysis.
RT is a curative option in the treatment of limited stage FL. If RT of microscopically uninvolved area is necessary, a reduction in the radiation dose should be carefully weighed against the risk of in-field recurrences.
本研究旨在分析单纯接受放疗（RT）治疗的 I-III 期滤泡性淋巴瘤（FL）患者的缓解率和结局。
回顾性分析了 1988 年至 2009 年期间在我科接受单纯 RT 治疗的 50 例 I-III 期 FL 患者的病历资料。中位年龄为 60 岁（范围 32-80 岁），中位随访时间为 8 年（范围 4-11 年）。临床分期采用 Ann Arbor 系统。I 期：30 例（60%），II 期：15 例（30%），III 期：5 例（10%）。32 例（64%）患者表现为淋巴结疾病，14 例（28%）患者表现为结外疾病，4 例（8%）患者有淋巴结和结外累及。26 例（52%）患者的 RT 照射野仅包括受累的区域淋巴结（累及野放疗），6 例（12%）患者接受了斗篷野和全腹盆腔照射，10 例（20%）患者接受了斗篷野照射，5 例（10%）患者接受了全腹盆腔照射，3 例（6%）患者接受了所谓的迷你斗篷野照射。总 RT 剂量范围为 26-56 Gy（中位剂量 40 Gy），每日分割剂量为 1.2-2.5 Gy。
完全缓解（CR）和部分缓解（PR）分别见于 39 例（76%）和 9 例（20%）患者。仅有 2/8 例（25%）肿瘤体积>5 cm 的患者达到了 CR，而 42 例最大淋巴瘤直径<5 cm 的患者中有 37 例（88%）达到了 CR（p=0.0001）。中位总生存期（OS）和中位无事件生存期（EFS）分别为 18 年（95%CI 10-26 年）和 7 年（6-8 年）。2 年、5 年和 10 年 OS 分别为 96±3%、90±5%和 70±9%。2 年、5 年和 10 年 EFS 分别为 90±5%、70±7%和 38±9%。15 例患者在放疗野外出现复发（30%），4 例患者出现野内复发（8%）。所有野内复发均发生在无临床（肉眼）受累的区域，这些区域接受的照射剂量≤26 Gy。单因素分析显示，治疗前最大淋巴瘤直径<5 cm（p=0.039）和 RT 后完全缓解（p=0.021）与更好的 OS 显著相关。
RT 是治疗局限性 FL 的一种有治愈可能的治疗方法。如果需要对显微镜下未累及的区域进行放疗，应仔细权衡降低放疗剂量与发生野内复发的风险。
