早期原发扁桃体非霍奇金淋巴瘤的治疗

Treatment of early stage primary tonsil non-Hodgkin's lymphoma

目的 分析早期原发扁桃体非霍奇金淋巴瘤 (NHL)的治疗。方法 分析 1983年 1月至1997年 12月初治的、有病理证实的 2 13例早期原发扁桃体非霍奇金淋巴瘤。根据AnnArbor分期 ,Ⅰ期 35例 ,Ⅱ期 178例。Ⅰ期单纯放射治疗 12例 ,综合治疗 2 3例 ;Ⅱ期单纯放射治疗 5 7例 ,单纯化疗 2例 ,综合治疗 119例。结果 全组 5年总生存率、癌症相关生存率和无病生存率分别为 6 5 %、70 %和6 1%。全组单纯放射治疗和综合治疗的 5年癌症相关生存率分别为 6 3%和 72 %(P >0 .0 5 ) ,5年无病生存率分别为 5 6 %和 6 2 %(P >0 .0 5 )。Ⅰ期患者单纯放射治疗和综合治疗的 5年癌症相关生存率均为 10 0 %;5年无病生存率分别为 10 0 %和 80 %,两者差异无显著性 (P >0 .0 5 )。Ⅱ期患者单纯放射治疗和综合治疗的 5年癌症相关生存率分别为 5 8%和 6 6 %,两者差异接近有显著性 (P =0 .0 5 1) ;5年无病生存率分别为 46 %和 6 0 %,两者差异有显著性 (P <0 .0 5 )。结论 Ⅰ期原发扁桃体NHL单纯放射治疗和综合治疗均取得好的疗效 ,综合治疗改善了Ⅱ期患者的无病生存率。综合治疗可改善早期扁桃体非霍奇金淋巴瘤患者的生存率。

Objective To investigate the treatment for patients with early stage primary tonsil non-Hodgkin's lymphoma (NHL). Methods Two hundred and thirteen patients with previously untreated early stage primary tonsil NHL were reviewed. All patients were pathologically confirmed. According to Ann Arbor classification, 35 patients were stage Ⅰ, 178 stage Ⅱ. The primary treatment for stage Ⅰ was radiotherapy alone in 12 and combined modality therapy (CMT) in 23 patients. The primary treatment for stage Ⅱ was radiotherapy alone in 57, chemotherapy alone in 2, and CMT in 119 patients. Results The 5-year overall survival, cancer specific survival (CSS) and disease-free survival (DFS) for the early stage primary tonsil non-Hodgkin's lymphoma were 65%,70% and 61%,respectively. The 5-year CSS was 63% for the radiotherapy alone group and 72% for the CMT group (P=0.064), and the 5-year DFS were 56% for the radiotherapy alone group and 62% for the CMT group. For patients with stageⅠdisease, the 5-year CSS were 100% in both radiotherapy alone and CMT groups, and the 5-year DFS were 100% and 80% in these two groups(P=0.148), respectively. There was no significant difference of efficacy between the two treatments for the patients with stageⅠ disease. For the patients with stageⅡ disease, the 5-year CSS was 58% in radiotherapy alone group and 66% in CMT group(P=0.051). However, CMT significantly improved DFS in stageⅡdisease, with a 5-year DFS of 46% for radiotherapy alone and 60% for CMT(P=0 046). Conclusion Patients with stageⅠ tonsil non-Hodgkin's lymphoma treated with radiotherapy alone or CMT can achieve an excellent outcome. CMT significantly improve the DFS in stageⅡ patients. There was a trend that CMT improved the survival rates in the patient with early stage disease. It was suggested that CMT should be used for the patients with early stage primary tonsil non-Hodgkin's lymphoma.