扁桃体非霍奇金淋巴瘤疗效分析

Analysis of Treatment result of Tonsillar Non Hondgkin's Lymphoma

目的 :分析扁桃体非霍奇金淋巴瘤的治疗方法、治疗效果及治疗失败的主要原因 ,并探讨影响预后的主要因素。方法 :回顾分析 1988～ 1993年收治扁桃体非霍奇金淋巴瘤 57例临床资料。结果 :以寿命表法统计 5年生存率 ,全组 5年总生存率为 4 6.5% ,其中Ⅰ～Ⅳ期分别为 75.0 %、58.7%、0 0、0 0。CR率为 59.7% ,残存率 (PR +MR +PD)为 4 0 .3%。CR组 5年生存率为 64.7% ,残存组无 1例生存 2年。治疗后肿瘤退缩情况与治疗前患者的体力状况、临床分期、瘤体大小、病理类型、有否伴B症状密切相关。结论 :Ⅱ期以上中高度恶性NHL宜行化疗 +放射治疗 +化疗综合治疗。初治时达CR是提高生存率的关键 ,复发和全身播散是治疗失败的主要原因。治疗前卡氏评分 <60分 ,伴B症状 ,病理为高度恶性Ⅲ、Ⅳ期NHL ,治疗中B症状未改善 。

Objective:To evaluate treatment method, result and main cause of failure and prognostic factors of tonsillar Non Hondgkin's lymphoma. Methods:Fifty seven patients of tonsillar NHL were treated in our hospital from 1988 to 1993. The age ranged from 16 to 76,with a median age of 48. Ann Arbor was used for staging,including stage I 4 cases, stage Ⅱ 29 cases,stage Ⅲ9 cases,stage Ⅳ 5 cases. Seven patients had B Symptoms.Working Formulation was used in pathologic classification which was low grade 3 cases, intermediate grade 29 cases,high grade 20 cases and undivided 5 cases. Seven cases were treated by radiotherapy alone, 50 cases with chemotherapy and radiotherapy. When more than 2 tonsil sites were involved or with B Symptoms,or lymph nodes enlargement more than 5 cm in diameter, one cycle of chemotherapy was given before irradiation. CHOP or COPP regimen was given for 2-6 cycles. The local extended fields which include Waldeyer's ring and total cervical lymph nodes were irradiated by 60 Co and deep X rays.Results: The life table method was used for 5 year survival rate. The whole 5 year survival rate was 46.5%, They were 75 0%,58 7%,0 0,0 0. respectively.CR rate was 59.7% and residual rate(PR+MR+PD) were 40.3%. The residual group had no 2 years survival. In the end of the treatment, the tumor regressive condition was closely related to the chinical stage, the type of pathological, the whole health condition before treatment and with B symptoms or without B symptoms. Conclusions: It is suggested that patient with above stage Ⅱ,intermediary and high grade malignant should use chemotherapy followed by radiation then chemotherapy. The key of raising survival rate was the achivement of CR at the first treatment:Recurrence and diffusion were the main cause of failure. The prognosis was very poor those who before treatment the Karnofsky scores was <60 or with B symptoms or high grade of stage Ⅲ;the B symptoms had not changed during the treatment or after treatment the tumor was residual.