| Background and ObjectionExtranodal nasal type NK/T-cell lymphoma is more common in Asia and South America,but in the United States and Europe is rare.It accounts for 20%to 30%of all non-Hodgkin's lymphoma(NHL)and it is the most common subtype of peripheral T-cell lymphoma in China.The nasal cavity is the most common primary site of extranodal nasal type NK/T-cell lymphoma,called nasal NK/T-cell lymphoma,followed by upper gastrointestinal organs such as nasopharynx,oropharynx and tonsils and other extranodal organs.Nasal NK/T-cell lymphoma is a rare malignant tumor of the nasopharynx.It is common in middle-aged men.65%~90%of patients are diagnosed with clinical stage I or II.The tumor often directly invades the nasal cavity and adjacent structures or tissues.It is more prone to local recurrence and distant metastasis.Nasal NK/T-cell lymphoma is sensitive to radiotherapy,but it is resistant to conventional chemotherapy,which is mainly represented by the CHOP regimen,and the new chemotherapy regimen containing asparaginase or gemcitabine is superior to the conventional regimen.At present,domestic treatment is mainly radiotherapy or radiotherapy combined with chemotherapy.The 5-year survival rate of early patients is 40%~84%,the disease progresses is rapid,the recurrence rate is high,and the prognosis is poor.Multi-disciplinary comprehensive treatment is needed to improve the curative effect.Hyperthermia is a new type of tumor-assisted treatment.It can induce cell physiology changes by increasing temperature,not only can directly kill cancer cells,but also increase the sensitivity of cells to radiotherapy and chemotherapy.It has a good effect in the comprehensive treatment of tumors and has received more and more clinical attention in recent years.MethodsThe clinical data of 70 patients with IE~IIE nasal NK/T-cell lymphoma who were treated from January 2011 to March 2013 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.All patients were diagnosed by pathomorphology or immunohistochemistry before treatment.According to different treatment methods,they were randomly divided into control group(chemotherapy group)and observation group(hyperthermia and radiotherapy group).There are 35cases of each group.All the 70 patients with nasal NK/T-cell lymphoma received radiotherapy and chemotherapy,and the regimen was the same.Radiotherapy was performed on a linear accelerator with 6MV-X line intensity modulation.The dose of radiotherapy was 50~54Gy/25~27 f,2Gy/time,5 times/week.Sequential chemotherapy was given to 4 to 6 cycles of GDP:intravenous gemcitabine 800mg/m~2,d1,8+cisplatin 20 mg/m~2,d1~4+dexamethasone 15 mg/m~2,d1~5,21d for one cycle.The observation group was given deep nasal hyperthermia and treated with915-Hz frequency WR-II microwave therapy machine for 40~50min/time,2times/week,and each hyperthermia was performed within 1h before and after radiotherapy.All patients with toxic side effects during the treatment were given symptomatic treatment.The observed indicators were complete response rate(CR),effective rate(CR+PR),5-year survival rate,5-year progression-free survival,and adverse events.Qualitative data were analyzed by?2 test,Kaplan-Meier method was used to plot survival curves,and Log-rank method was used to test differences.ResultsThe complete remission rate of primary lesions in the observation group and the control group was 77.14%and 54.29%(P=0.044),and the 5-year recurrence-free survival rate was 68.59%and 58.46%respectively(P=0.040).The rates were 71.31%and 59.57%respectively(P=0.049),and the two groups were statistically significant.The distant metastasis rate of the observation group was 17.14%,and the distant metastasis rate of the control group was 25.71%.The difference was not statistically significant(P=0.382).The toxic and side effects of the two groups were mainly grade I~II bone marrow suppression,gastrointestinal reactions,skin reactions and oral mucosal reactions.No adverse reactions of grade IV or higher were relieved or disappeared after symptomatic treatment.The toxicity and side effects between the two groups was no significant difference(P>0.05).ConclusionHyperthermia combined with radiotherapy and chemotherapy for early nasal NK/T-cell lymphoma is superior to radiotherapy and chemotherapy,and the former does not increase the probability of distant metastasis and toxic side effects,safe and effective.Compared with chemoradiotherapy,hyperthermia combined with radiotherapy and chemotherapy has a tendency to improve the long-term overall survival of patients with NK~T-cell lymphoma in IE~IIE. |
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