Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
Department of Dermatology, University Hospital Muenster, Von-Esmarch-Straße 58, 48149, Muenster, Germany.
Strahlenther Onkol. 2020 Feb;196(2):126-131. doi: 10.1007/s00066-019-01541-7. Epub 2019 Nov 22.
Radiotherapy (RT) has an established role in the curative treatment of indolent primary cutaneous B‑cell lymphoma (PCBCL). With the role of low-dose regimens such as 2 × 2 Gy being uncertain, we compared conventional-dose RT to a low-dose approach and investigated outcome and toxicities.
We retrospectively reviewed the medical records of 26 patients with 44 cutaneous lesions treated at our institution between 2007 and 2017, comprising 22 marginal zone lymphoma (PCMZL) lesions and 22 follicle center lymphoma (PCFCL) lesions. Seven lesions (16%) were treated with low-dose RT (LDRT) (4 Gy) and 37 (84%) with conventional-dose RT (≥24 Gy, median 40 Gy). Median follow-up duration was 76 months.
The overall response rate (ORR) was 91% (complete response rate [CRR]: 75%). The 5‑year local control rate (LCR) was 88% and the 10-year LCR was 84%. The response rates were significantly higher following conventional-dose RT (ORR: 92% vs. 86%; CRR: 84% vs. 29%; P = 0.007). In terms of radiation dose, the rate of infield relapses (14% vs. 11%, P = 0.4) and the 5‑year LCR (86% vs. 90%, P = 0.4) were comparable in the LDRT and conventional-dose RT groups. During RT courses, about two-thirds of patients experienced mild toxicities, with grade I and II acute toxicity rates of 61% and 9%, respectively, with lower incidences of grade I (14% vs. 70%) and grade II (0% vs. 8%, P = 0.004) toxicities following LDRT.
This long-term analysis confirms the excellent outcome of RT in the management of PCBCL. The LDRT concept with 4 Gy was associated with a comparable LCR and reduced rates of acute toxicity. However, the response rates were significantly lower for this group and LDRT may therefore not be recommended as standard treatment.
放射治疗（RT）在惰性原发性皮肤 B 细胞淋巴瘤（PCBCL）的治愈性治疗中具有既定作用。由于低剂量方案（如 2×2 Gy）的作用尚不确定，我们将常规剂量 RT 与低剂量方法进行了比较，并研究了结果和毒性。
我们回顾性地分析了 2007 年至 2017 年间在我们机构治疗的 26 例 44 处皮肤病变患者的病历，其中包括 22 例边缘区淋巴瘤（PCMZL）病变和 22 例滤泡中心淋巴瘤（PCFCL）病变。7 处病变（16%）接受低剂量 RT（LDRT）（4 Gy）治疗，37 处（84%）接受常规剂量 RT（≥24 Gy，中位数 40 Gy）治疗。中位随访时间为 76 个月。
总缓解率（ORR）为 91%（完全缓解率[CRR]：75%）。5 年局部控制率（LCR）为 88%，10 年 LCR 为 84%。常规剂量 RT 后，反应率明显更高（ORR：92%比 86%；CRR：84%比 29%；P=0.007）。就辐射剂量而言，低剂量 RT 组和常规剂量 RT 组的场内复发率（14%比 11%，P=0.4）和 5 年 LCR（86%比 90%，P=0.4）相当。在 RT 过程中，约三分之二的患者出现轻度毒性，急性毒性 1 级和 2 级发生率分别为 61%和 9%，低剂量 RT 组 1 级（14%比 70%）和 2 级（0%比 8%，P=0.004）毒性发生率较低。
这项长期分析证实了 RT 在 PCBCL 治疗中的出色疗效。4 Gy 的低剂量 RT 概念与相当的 LCR 和较低的急性毒性发生率相关。然而，该组的反应率明显较低，因此低剂量 RT 可能不推荐作为标准治疗。
