Kwak Yoo-Kang, Choi Byung-Ock, Kim Sung Hwan, Lee Joo Hwan, Kang Dae Gyu, Lee Jong Hoon
Department of Radiation Oncology, St. Vincent's Hospital Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Medicine (Baltimore). 2017 Jun;96(25):e7268. doi: 10.1097/MD.0000000000007268.
This study was performed to analyze the treatment outcome for diffuse large B-cell lymphoma (DLBCL) involving the head and neck and to evaluate the role of radiotherapy in the rituximab era. Fifty-six patients diagnosed with DLBCL involving the head and neck were assessed. All patients were treated with 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone (R-CHOP). After chemotherapy, radiation was delivered to the head and neck area in a median dose of 36 Gy. Radiation was delivered using 3-dimensional radiotherapy (n = 25) or intensity-modulated radiotherapy (n = 31). Primary endpoints were relapse-free survival (RFS), overall survival (OS), and local control rate. After median follow-up time of 45 months, the 5-year RFS and OS rates were 72% and 61%, respectively. Fourteen (25%) of 56 patients relapsed; 1 had a local relapse, 11 had distant relapses, and 2 had both local and distant relapses. The final local control rate after radiotherapy was 94%. Age, performance status, international prognostic index score, and radiotherapy response were significant prognostic factors for both RFS and OS in the multivariate analysis. Incidence of acute grade 3 and 4 hematologic toxicity was 9% and 4%, respectively. Grade 3 nonhematologic toxicity occurred in 2 (4%) patients, and there was no grade 4 nonhematologic toxicity for the irradiated patients. Excellent local control and survival rates can be achieved with R-CHOP followed by radiotherapy in patients with DLBCL involving the head and neck. Treatment-related toxicity after the introduction of modern radiotherapy was acceptable and limited.
本研究旨在分析头颈部弥漫性大B细胞淋巴瘤（DLBCL）的治疗结果，并评估放疗在利妥昔单抗时代的作用。对56例诊断为头颈部DLBCL的患者进行了评估。所有患者均接受6个周期的利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松龙（R-CHOP）治疗。化疗后，对头颈部区域进行放疗，中位剂量为36 Gy。放疗采用三维适形放疗（n = 25）或调强放疗（n = 31）。主要终点为无复发生存期（RFS）、总生存期（OS）和局部控制率。中位随访时间45个月后，5年RFS率和OS率分别为72%和61%。56例患者中有14例（25%）复发；1例为局部复发，11例为远处复发，2例为局部和远处均复发。放疗后的最终局部控制率为94%。在多因素分析中，年龄、体能状态、国际预后指数评分和放疗反应是RFS和OS的重要预后因素。急性3级和4级血液学毒性的发生率分别为9%和4%。2例（4%）患者发生3级非血液学毒性，接受放疗的患者未发生4级非血液学毒性。对于头颈部DLBCL患者，采用R-CHOP方案化疗后行放疗可获得良好的局部控制率和生存率。引入现代放疗后，治疗相关毒性是可接受的且有限。
