Ⅱ期咽淋巴环非霍奇金淋巴瘤治疗探讨

Treatment policy for stage ⅡnonHodgkin's lymphoma of Waldeyer's ring

目的探讨Ⅱ期咽淋巴环非霍奇金淋巴瘤的治疗。材料与方法１９８７年１月至１９９２年９月共收治Ⅱ期咽淋巴环淋巴瘤１３２例。疗前常规作上消化道钡餐检查（ＧＩ），原则上作化、放综合治疗。１９８９年２月前后分别用ＣＯＭＰ（环磷酰胺、长春新碱、氨甲蝶呤、强的松）和ＣＨＯＰ（环磷酰胺、长春新碱、阿霉素、强的松）方案化疗。放疗前后各化疗２～３周期，放疗常规用面颈联合野，照射剂量４０～６０Ｇｙ／４～７周。结果ＧＩ查出６例胃受累，但均为纤维胃镜否定。ＣＨＯＰ组完全缓解（ＣＲ）率为６１．２％，部分缓解（ＰＲ）率３８．８％。ＣＲ者５年生存率为９０．０％，ＰＲ者为５７．９％（Ｐ＜０．０１）。ＣＨＯＰ组５年生存率为７６．３％，ＣＯＭＰ组为４６．３％（Ｐ＜０．００５）。放疗剂量＜５０Ｇｙ与≥５０Ｇｙ生存率无明显差异。有６例特别病例先用ＣＨＯＰ化疗达ＣＲ，１例未放疗，另５例仅分别照射２０，３４，３６，３８，和３８Ｇｙ。这６例均无瘤生存５年以上。结论疗前分期检查中似可不必再作ＧＩ。ＣＨＯＰ方案化疗明显提高生存率，建议Ⅱ期患者应首选化疗。化疗达ＣＲ者酌降照射剂量。

Purpose To evaluate the treatment policy for stage Ⅱ nonHodgkin's lymphoma of Waldeyer's ring.Materials and Methods From Jan. 1987 to Sep. 1992,132 stage Ⅱ patients with nonHodgkin's lymphoma of Waldeyer's ring were treated with chemotherapy and radiotherapy.Before treatment, upper gastrointestinal radiography (GI) was applied for all patients. Chemotherapy of COMP regimen was performed before Feb. 1989 and CHOP regimen was given after Feb. 1989. Two or three cycles chemotherapy were given before and after radiation, respectively. Radiotherapy was given through faciocervical fields with the total dose of 40～60Gy/4～7w.Results Among 132 patients,only 6 patients had stomach involvement detected by GI. However, gastric endoscopy findings were negative in all patients. The complete response (CR) of induced chemotherapy with CHOP regimen was 61.2% and PR, 38.8%. The 5year survival rates of CR and PR groups were 90.0% and 57.9%,respectively (P<0.01). The overall 5year survival rate was 76.3% in CHOP group and 46.3% in the COMP group (P<0.005). There was no significant difference of the 5year survival rate between patients who received the radiation doses of < 50Gy and ≥ 50Gy. There were 6 particular patients, who received CHOP chemotherapy initially and all achieved CR. After that, one patients had no radiation, the other patients were given radiation of 20,34,36,38 and 38Gy,respectively. All those 6 patients were no evidence of disease till Sep. 1997.Conclusion It seems that GI is not necessory in the staging workup before treatment. The CHOP chemotherapy gives a better 5year survival significantly. We suggest that initial chemotherapy with CHOP regimen be the treatment of choice for stage Ⅱ patient with nonHodgkin's lyphoma of Waldeyer's ring,while CR achieved,radiation dose can be reduced properly.