| Objective To investigate the clinical features,treatment methods and prognosis of early nasal extranodal NK/T-cell lymphoma,nasal type.Methods The clinical data of 93 patients with early nasal extranodal NK/T cell lymphoma treated were retrospectively analyzed from January 1,2012 to December31,2018 at Department of Radiation Oncology,The First Affiliated Hospital of Bengbu Medical College.Detailed information about age,gender,B symptom,ECOG scores,primary tumor location,stage,lactate dehydrogenase level,lymph node involvement,treatment pattern,chemotherapy regimen,and radiotherapy target dose were recorded.To analyze the short-term efficacy and long-term survival of different treatment modes in precision radiotherapy mode.Survival analysis was performed by Kaplan-Meier method.Log-rank test was used to compare the survival rate between the two factors.The ?2 test was used for the classification data and COX regression analysis was used for the multivariate analysis.The difference was statistically significant at P<0.05.Result 1.Clinical data characteristics : There were 26 cases in stage limited ?E.There were 30 cases in stage Extensive ?E.There were 37 cases in stage ?E.The ratio of male to female was 2.6:1;the median age of onset was 45 years old.73.1% of primary tumor location were in the nasal cavity.23.7% of patients had B symptoms.72.0% of patients had ECOG score of 0-1.30.1% of patients had elevated lactate dehydrogenase;65.6% had IPI score of 0-1.32 patients(30.1%)received radiotherapy alone,and 41 patients(44.1%)treated with sequential radiotherapy,24 patients(25.8%)received concurrent chemoradiotherapy followed by chemotherapy.59patients(63.4%)received ?54Gy,while 34 patients(36.6%)radiotherapy target dose<54Gy.18 patients(32.1%)Of Stage ?E patients received Preventive radiation therapy to the cervical lymph nodes.2.Response evaluation : 65 patients in the whole group reached complete remission,17 reached partial remission,the complete remission rate was 69.8%,and the overall response rate was 88.1%.For patients who received radiotherapy alone,the complete remission rate was 75.0%,the overall response was 89.2%.For patients who received sequential radiotherapy,the complete remission rate was 58.5%,the overall response was 82.9%.For patients who received concurrent chemoradiotherapy followed by chemotherapy,the Complete Remission rate was83.3% and the overall response was 95.8%.3.Long-term survival: 24 patients died in the whole group,with a median survival time of 59 months,5-year overall survival(OS)rate was 68.3%,and 5-year progression free survival(PFS)rate was57.2%.(1)For patients with ?E patients,the5-year OS rate was 72.5% and 77.8%(P=0.698>0.05).The 5-year PFS rates were69.3% and 71.7%,respectively.(P=0.846>0.05)(2)Patients with stage ?E: The5-year OS rate of patients receiving radiotherapy alone and chemoradiotherapy were51.2% and 65.6%,respectively(P=0.032<0.05);the 5-year PFS rates were 44.9%,60.4%(P=0.045 <0.05);(3)The 5-year OS rates of concurrent chemoradiotherapy and sequential chemoradiotherapy were 59.4% and 74.3%,respectively(P=0.04<0.05).The 5-year PFS rate was 67.8% and 51.2%(P=0.024).<0.05)(4)The5-year OS rate of patients with anthracyclines and non-anthracyclines was 51.5% and73.6%(P=0.028<0.05),and the 5-year PFS rates were 37.5% and 60.6%,respectively.=0.013<0.05)(5)The 5-year OS rate of patients who received radiation dose ?54Gy and dose 50-54 Gy were 70.5% and 67.0%,respectively(P=0.654>0.05);the 5-year PFS was 61.4% and 55.2%,respectively.=0.726>0.05)(6)For patients who received Preventive radiation therapy to the cervical lymph nodes,Compared with patients without cervical lymph node irradiation,the 5-year OS rate was 79.6% and 72.4%,respectively(P=0.874>0.05);the 5-year PFS was 71.3%,64.9%(P=0.667>0.05).4.Toxicity: The incidence of grade 3-4 hematologic toxicity was 45.8%,and the incidence of 3-4 grade radioactive mucositis was 20.8% in patients who received concurrent chemoradiotherapy.5.Univariate analysis showed that age(P = 0.0.009),LDH(P = 0.037),primarytumor site(P = 0.028),stage(P = 0.041),CR(P = 0.000)had an effect on OS Statistical significance;age(P=0.008),LDH(P=0.004),primary site(P=0.019),stage(P=0.013),and CR(P=0.000)had statistical effects significantly on PFS.Multivariate analysis of Cox regression model showed that age and CR were independent influencing factors of OS and PFS.Conclusion 1.IMRT is the main treatment for early extranodal NK/T cell lymphoma,nasal type.The appropriate dose for the radiotherapy target should not be less than 50 Gy.Higher doses do not bring survival benefits.For patients with stage ?E,there is no need of preventive radiation therapy to the cervical lymph nodes.2.For patients with stage ?E,long-term survival of patients who receive radiotherapy combined with chemotherapy is higher than radiotherapy alone.3.non-anthracyclines are more effective than anthracyclines.Concurrent chemoradiotherapy show good efficacy,but the incidence of acute toxicity was higher.4.Age and complete remission are independent factors affecting prognosis.They are meaningful for prognosis evaluation.Age >60 years old,patients who do not reach complete remission after treatment have a poor prognosis. |
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