眼附属器淋巴瘤的放疗剂量和体积缩小。

Radiotherapy Dose and Volume De-escalation in Ocular Adnexal Lymphoma.

机构信息

Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany.

Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany

出版信息

Anticancer Res. 2020 Jul;40(7):4041-4046. doi: 10.21873/anticanres.14400.

DOI:10.21873/anticanres.14400

PMID:32620650

Abstract

AIM

Modern radiotherapy (RT) technique and therapy de-escalation have led to encouraging results in lymphoma management. In this study, we aimed to describe the oncological and toxicity outcome in patients with ocular adnexal lymphoma.

PATIENTS AND METHODS

A total of 45 patients with 52 orbital lesions who were treated at our Institution between 2003 and 2019 were considered. Clinical characteristics, treatment outcomes, and toxicity were assessed. Patients receiving 4-6 Gy were categorized as receiving ultra-low-dose RT, 24-30.6 Gy as standard-dose RT, and >30.6 Gy as high-dose RT.

RESULTS

The predominant histological subtype was marginal zone lymphoma in 39 lesions (75%). Radiation dose ranged from 4-50.4 Gy. In the whole cohort, 11% of the lesions were treated with ultra-low-dose RT, 33% with standard-dose RT, and 56% with high-dose RT; 60% of lesions were treated using intensity-modulated RT (IMRT), while 44% of lesions were treated with partial orbital RT. The median duration of follow-up was 33 months. The overall response rate was 94% (complete response rate=83%). The 5-year local control rate, progression-free survival, and overall survival were 100%, 76%, and 92%, respectively. We did not detect any significant difference in progression-free or overall survival regarding different radiation doses and volumes. Ultra-low-dose RT was associated with a significantly lower rate of grade 2 late toxicities (0% vs. 6% and 31%, p=0.05) in comparison with standard-dose and high-dose RT, respectively. Patients who received IMRT had a significant fewer acute grade 2 (16% vs. 43%, p=0.05) and a trend towards lower late grade 2 toxicities (9% vs. 33%, p=0.06).

CONCLUSION

Radiation dose and volume de-escalation seem to be safe and effective, with excellent local control and survival in the management of ocular adnexal lymphoma. IMRT seems to be associated with less toxicity.

摘要

目的

现代放疗（RT）技术和治疗强度降低使得淋巴瘤的治疗效果令人鼓舞。本研究旨在描述眼附属器淋巴瘤患者的肿瘤学和毒性结果。

方法

共纳入 2003 年至 2019 年在我院治疗的 45 例 52 个眼眶病变患者。评估了临床特征、治疗结果和毒性。接受 4-6Gy 治疗的患者归类为接受超低剂量 RT，24-30.6Gy 为标准剂量 RT，>30.6Gy 为高剂量 RT。

结果

39 个病变（75%）的主要组织学亚型为边缘区淋巴瘤。放射剂量范围为 4-50.4Gy。在整个队列中，11%的病变接受超低剂量 RT，33%接受标准剂量 RT，56%接受高剂量 RT；60%的病变采用调强放疗（IMRT），44%的病变采用部分眼眶 RT。中位随访时间为 33 个月。总体缓解率为 94%（完全缓解率=83%）。5 年局部控制率、无进展生存率和总生存率分别为 100%、76%和 92%。我们没有发现不同放疗剂量和体积对无进展生存率和总生存率有显著影响。与标准剂量和高剂量 RT 相比，超低剂量 RT 显著降低了 2 级晚期毒性的发生率（0%比 6%和 31%，p=0.05）。接受 IMRT 的患者急性 2 级毒性（16%比 43%，p=0.05）和晚期 2 级毒性发生率（9%比 33%，p=0.06）明显降低。