| Objective: To evaluate the efficacy and side effects of P-Gemox regimen combined with Intensity Modulated radiotherapy in the treatment of Extranodal Nasaltype Natural Killer/T-cell Lymphoma(ENKTL).Methods: From July 2014 to October 2019,60 patients with ENKTL confirmed by pathomorphology and immunohistochemistry were collected from the Department of lymphoma,Guizhou cancer hospital.All patients received P-Gemox chemotherapy for at least 2cycles.Patients with stage I-II ENKTL completed 2 cycles of induction chemotherapy and then received radiotherapy.PTV dose at the infiltrating site of primary tumor was50.52Gy-52.20 Gy,GTV dose of 55.12 Gy,and those who did not reach CR after radiotherapy were given 2-4 cycles of chemotherapy;stage III-IV patients who completed 4-6 cycles of induction chemotherapy were given residual focus field radiotherapy,PTV dose of 50Gy-55 Gy,and the efficacy was evaluated again after treatment.Results:Among 60 patients with ENKTL,39 were male and 21 were female,the ratio of male to female was 1.86:1,the age was 21-71 years,the median age was 45 years.According to the Ann Arbor international staging standard,there were 15 cases in stage I,30 cases in stage II,7 cases in stage III and 8 cases in stage IV.There were 53 cases with primary nasal lesions,19 cases with B symptoms,26 cases with LDH higher than the upper limit of normal range,22 cases with KPI 0-1score,30 cases with Ki-67 value ? 65%,9 cases with Hemophagocytic syndrome,53 cases with ECOG 0-1 score.The median follow-up time was 17.4 months,the follow-up rate was 100%.After treatment,the complete remission rate was 65.0%(39/ 60),the partial remission rate was 25.0%(15 / 60),the total effective rate was 90%(54 / 60),the disease stability(SD)rate was 3.3%(2 / 60),and the disease progression(PD)rate was 6.7%(4 / 60).The 1,2 and 3-year overall survival rate(OS)was :91%,75%,69%,and progression-free survival(PFS)was 86%,68% and 62%,respectively.During the treatment period and within one year after the treatment,4cases died due to disease progress and infection.The causes of death were 2 case of disease progress and 2 cases of infection.According to Chi square test,ECOG score,combined with Hemophagocytic syndrome and KPI score were important factors influencing the short-term treatment effect of patients with extranodal nasal type NK /T-cell lymphoma.At the same time,Cox multivariate analysis showed that combined with Hemophagocytic syndrome and radiotherapy dose were related to the prognosis of patients(P < 0.05).The main side effects of this regimen are myelosuppression,transaminase elevation,gastrointestinal reaction and radiation mucositis,which are mostly mild to moderate,and can be relieved after symptomatic treatment or stop of radiotherapy and chemotherapy.There is no treatment-related death in this study.Conclusion: As a first-line induction chemotherapy regimen combined with conformal intensity modulated radiotherapy,p-gemox has a good short-term efficacy,mild adverse reactions,good safety and high clinical application value in the treatment of nasal NK/ t-cell lymphoma.It is a new treatment choice for nasal NK/t-cell lymphoma Hemophagocytic syndrome and radiotherapy dose are independent risk factors for prognosis. |
PDF Full Text Request