击中移动目标：采用容积图像引导调强放射治疗成功治疗累及肠系膜的弥漫性大 B 细胞淋巴瘤。
Hitting a Moving Target: Successful Management of Diffuse Large B-cell Lymphoma Involving the Mesentery With Volumetric Image-guided Intensity Modulated Radiation Therapy.
机构信息
Baylor College of Medicine, Houston, TX.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
Clin Lymphoma Myeloma Leuk. 2019 Jan;19(1):e51-e61. doi: 10.1016/j.clml.2018.09.002. Epub 2018 Sep 10.
INTRODUCTION
We report successful treatment of mesenteric diffuse large B-cell lymphoma (DLBCL) using localized involved site radiation therapy (ISRT), intensity modulated radiation therapy (IMRT), and daily computed tomography (CT)-image guidance.
PATIENTS AND METHODS
Patients with mesenteric DLBCL treated with RT between 2011 and 2017 were reviewed. Clinical and treatment characteristics were analyzed for an association with local control, progression-free survival (PFS), and overall survival.
RESULTS
Twenty-three patients were eligible. At diagnosis, the median age was 52 years (range, 38-76 years), and 57% (n = 13) had stage I/II DLBCL. All patients received frontline chemotherapy (ChT) (R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone], n = 19; dose-adjusted R-EPOCH [rituximab, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin], n = 4) with median 6 cycles. Prior to RT, salvage ChT for refractory DLBCL was given to 43% (n = 10) and autologous stem cell transplantation was administered in 13% (n = 3). At the time of RT, positron emission tomography-CT revealed 5-point scale of 1 to 3 (48%; n = 11), 4 (9%; n = 2), and 5 (44%; n = 10). All patients received IMRT, daily CT imaging, and ISRT. The median RT dose was 40 Gy (range, 16.2-49.4 Gy). Relapse or progression occurred in 22% (n = 5). At a median follow-up of 37 months, the 3-year local control, PFS, and overall survival rates were 80%, 75%, and 96%, respectively. Among patients treated with RT after complete metabolic response to frontline ChT (n = 8), the 3-year PFS was 100%, compared with 61% for patients with a history of chemorefractory DLBCL (n = 15; P = .055). Four of the 5 relapses occurred in patients with 5-point scale of 5 prior to RT (P = .127).
CONCLUSION
Mesenteric involvement of DLBCL can be successfully targeted with localized ISRT fields using IMRT and daily CT-image guidance.
简介
我们报告了使用局部受累部位放射治疗（ISRT）、调强放射治疗（IMRT）和每日计算机断层扫描（CT）图像引导成功治疗肠系膜弥漫性大 B 细胞淋巴瘤（DLBCL）的情况。
患者和方法
回顾了 2011 年至 2017 年间接受 RT 治疗的肠系膜 DLBCL 患者。分析了临床和治疗特征与局部控制、无进展生存期（PFS）和总生存期的关系。
结果
23 名患者符合条件。在诊断时，中位年龄为 52 岁（范围，38-76 岁），57%（n=13）为 I/II 期 DLBCL。所有患者均接受一线化疗（ChT）（R-CHOP[利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松]，n=19；剂量调整的 EPOCH[利妥昔单抗、依托泊苷、泼尼松、长春新碱、环磷酰胺和多柔比星]，n=4），中位周期数为 6 个。在 RT 前，43%（n=10）的患者接受了难治性 DLBCL 的挽救性 ChT，13%（n=3）的患者接受了自体干细胞移植。在 RT 时，正电子发射断层扫描-CT 显示 5 分制为 1-3（48%；n=11）、4（9%；n=2）和 5（44%；n=10）。所有患者均接受 IMRT、每日 CT 成像和 ISRT。中位 RT 剂量为 40Gy（范围，16.2-49.4Gy）。22%（n=5）出现复发或进展。中位随访 37 个月后，3 年局部控制、PFS 和总生存率分别为 80%、75%和 96%。在接受一线 ChT 完全代谢反应后接受 RT 治疗的 8 名患者中，3 年 PFS 为 100%，而既往有化疗难治性 DLBCL 病史的 15 名患者为 61%（P=0.055）。5 次复发中有 4 次发生在 RT 前 5 分制为 5 的患者中（P=0.127）。
结论
使用 IMRT 和每日 CT 图像引导，可成功地用局部 ISRT 野靶向治疗肠系膜 DLBCL。
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