四种方法治疗鼻腔非霍奇金淋巴瘤的疗效比较

Compare the curative effect of Non-Hodgkin lymphoma by four types of therapy

目的评价化疗、放疗、放疗加化疗及自体外周血干细胞移植(APBSCT)联合全身照射(TBI)等4种治疗方法对原发鼻腔的非霍奇金淋巴瘤(N-NHL)的疗效。方法1980年至2000年间天津市肿瘤医院收治的原发N-NHL138例进行回顾分析。放射治疗:主野鼻前“凸”字野,辅单或双侧耳前野,累及口咽者先用面颈联合野。鼻腔靶区中位剂量56.0(35.2～75.5)Gy。化疗:放射治疗前、中、后或单纯化疗,方案为COP,COPP,COMP,CHOP,COBDP。6例为APBST联合TBI。TBI组剂量为6MVX线8Gy,有2例原发灶加量30Gy。结果单化组、单放组、放疗加化疗组及APBST联合TBI组局部控制率分别为12%,69%,76%,83%;5年总生存率分别为9%,52%,63%,83%。APBSCT联合TBI组生存率优于放疗加化疗组,而放疗加化疗组优于单放组,单放组优于单化组(P<0.05)。结论放化疗结合的治疗应成为N-NHL的主要治疗方法,而APBSCT联合TBI取得了更好的疗效。

Objective To evaluate the curative effect of nasal non-Hodgkin lymphoma（N-NHL） by four types of therapy such as pure chemotherapy, pure radiotherapy, chemotherapy combined with radiotherapy, and APBSCT combined with TBI. Methods One hundred and thirty five patients with nasal NHL were treated between 1980 and 2000. All patients received radiotherapy alone or chemotherapy alone or radiotherapy combined with radiotherapy or TBI combined with APBSCT. The median radiation dose to the nasal cavity was 56.0 Gy with a range of 35.2 to 75.5 Gy. Six patients received TBI combined APBSCT. The TBI dose was 8 Gy. Two patients received 30 Gy in nasal of the six patients. The chemotherapy regimen consisted of 2-6 cycles of COP, COPP, COMP, CHOP, COBDP. Results The local control rate and 5-year survival rate of the four groups of pure chemotherapy, pure radiotherapy, combined chemotherapy and radiotherapy and APBSCT combined with TBI were 12 %, 69 %, 76 %, 83 % and 9 %, 52 %, 63 %, 83 %. For the four groups, the best is APBSCT, then combined chemotherapy and radiotherapy group ,then pure radiotherapy, the last is pure chemotherapy. There is significant difference between the four groups（P 〈0.05）. Conclusion Combined chemotherapy and radiotherapy become the most important methods to N-NHL, but APBSCT combined TBI achieved better effect.