摘要
目的 探讨R-CHOP联合三维适形调强放疗(IMRT)治疗中期疗效评价为部分缓解(PR)的初治弥漫性大B细胞淋巴瘤(DLBCL)患者的临床疗效与安全性.方法 对20例经一线R-CHOP治疗3周期后,中期疗效评价为PR的初治弥漫性大B细胞淋巴瘤患者,后续治疗采用同步放化疗(3周期R-CHOP联合局部残留病灶行IMRT放疗);收集患者的分期、性别、病理类型、是否为双表达型、是否合并HIV、年龄、乳酸脱氢酶水平(LDH)、B症状、结外累及部位数及国际预后指数(IPI评分)等一般临床资料,并在治疗结束后行即刻疗效评价[完全缓解(CR)、未确定的完全缓解(CRu)、部分缓解(PR)、客观有效率(CR+CRu+PR)],比较不同分期的疗效;根据随访结果记录复发患者的部位、时间及转归,以是否复发分组,分析复发相关危险因素;比较靶向化疗与同步放化疗期间的毒副反应,记录放疗局部放疗毒性.结果 同步放化疗结束后弥漫性大B细胞淋巴瘤患者即刻疗效结果显示,CR高于CRu、PR、CR+CRu+PR为100％;局限期患者较进展期患者显示出更高的CR率,差异有统计学意义(P<0.05);共有患者出现复发7例,仅1例出现放疗部位复发,放疗显示出较好的局部控制(94.7％);对患者一般临床资料进行分析,结果提示患者为进展期、非生发中心来源亚型、>60岁、LDH升高、伴B症状、IPI评分高者更易复发(P<0.05);同步放化疗期间Ⅲ～Ⅳ度白细胞/中性粒细胞、血小板降低、感染、因毒副反应导致化疗延期>7 d的发生率高于单纯靶向化疗期间(P<0.05);放疗局部反应主要表现为照射野内Ⅰ～Ⅱ级放射性反应,未出现大于3级急性放射性炎症,耐受性好.结论 R-CHOP联合三维适形调强放疗可以提高初治弥漫性大B细胞淋巴瘤的CR率,毒副反应可耐受,R-CHOP与放疗联合应用安全.
Abstract
Objective To investigate the clinical efficacy and safety of R-CHOP combined with intensity modulated radiation therapy ( IMRT ) in patients with initially treated diffuse large B-cell lymphoma (DLBCL) with mid-term efficacy evaluation of PR. Methods Twenty patients with diffuse large B-cell lymphoma with PR evaluation after 3 cycles of first-line R-CHOP were subsequently treated with concurrent chemoradiotherapy ( 3 cycles of R-CHOP combined with IMRT radiotherapy for local residual lesions) . The general clinical data of the patients were collected ( staging,gender,pathology types,co-expression type of not,combined HIV or not,age,LDH,B symptom,number of extra nodal affected parts and IPI scores);immediate efficacy evolution was carried out after treatment[complete response ( CR ),complete remission undetermined ( CRu ),partial response ( PR ),objectively response (CR+Cru+PR)]to compare efficacy of varied stages. Follow-up visit recorded relapsed body part,time and sequelae. Patients were grouped according to whether there was recurrence and risk factors related to recurrence were analyzed. Toxicity and side effects during targeted chemotherapy and concurrent chemoradiotherapy were compared,toxicity from chemoradiotherapy and local parts was recorded. Results The immediate efficacy after the end of concurrent radiotherapy and chemotherapy was as follows:CR was higher than CRu and PR. The CR+CRu+PR was 100％,and the CR rate of patients with limited stage was higher than advanced stage patients,difference was statistically significant ( P<0.05 ) . A total of seven patients relapsed with only one relapsed on the radio therapy part;radiotherapy showed good local control ( 94 . 7％) . General clinical data analysis showed that patients with advanced stage,non-germinal center origin subtype,over 60 years old,elevated LDH,accompanied by B symptoms,and high international prognostic index ( IPI) score were more likely to relapse (P<0.05). During concurrent chemoradiotherapy,incidence rate of Ⅲ to Ⅳ leukocyte/neutrophil granulocyte,decreased platelet,infection,toxicity caused chemotherapy delay>7 d was higher than that of targeted chemotherapy alone ( P<0.05 ) . Response from radiotherapy on local part manifested as Ⅰ to Ⅱ degrees of radioreaction within radial range,and there was no acute radial infection over Ⅲ degree which showed good tolerance. Conclusions R-CHOP combined with intensity modulated radiation therapy can improve the CR rate of initially treated diffuse large B-cell lymphoma,with toxicity tolerated by patients,and R-CHOP combined with radiotherapy is safe.
基金项目
贵州省卫生健康委科学技术基金项目(2021XMSB00032650)
维普
万方数据