摘要
目的评价化疗、放疗、放疗+化疗及自体外周血干细胞移植(APBSCT)联合全身放疗(TBI)四种治疗方法对原发鼻腔非霍奇金淋巴瘤的疗效,并对影响预后的因素进行分析。方法20年间收治的原发鼻腔非霍奇金淋巴瘤135例全部经病理证实,其中T细胞来源122例,B细胞来源12例,NK细胞来源1例。放疗主野为鼻前凸字野,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56.0Gy(35.2～75.5Gy)。TBI组剂量为8Gy,有2例原发灶加量30Gy。辅助化疗在放疗前、中、后进行或单纯化疗,方案为COP、COPP、COMP、CHOP、COBDP。用Cox模型对影响预后的多因素进行分析。结果单化组、单放组、放加化组及APBSCT联合TBI组局部控制率分别为12%、69%、76%、83%(P=0.057),5年总生存率分别为9%、52%、63%、83%(P=0.032)。除Ann Arbor分期外,局部侵犯范围、治疗方法也是影响预后的主要因素,而病理类型、性别、年龄及全身症状等因素对预后影响不大。结论放化联合的生存率优于单纯放疗。在AnnArbor分期的基础上依照局部侵犯部位进一步分区,对评价预后有意义。对于原发鼻腔非霍奇金淋巴瘤的治疗有条件者可试用APB SCT联合TBI。
Objective To evaluate the effects of nasal non-Hodgkin＇s lymphoma（N-NHL） treated with chemotherapy alone, radiotherapy alone, chemotherapy plus radiotherapy and autologous peripheral blood stem cell transplantation（APBSCT） combined with total body irradiation（TBI） ;and to analyze the impaet faetors of prognosis. Methods 135 patients were treated between 1980 and 2000. All were eonfimed by histopathology as N-NHL, ineluding 122 T eell in origin, 12 B eell and 1 NK eell in origin. The main radiotherapy portal was set in front of the nose with a spade-like protrusion, supplement with a portal next to the ear on one side or both sides. Combined portal in facial eervieal area was first used when there was invasion of the oropharynx. The median dose to the nasal eavity was 56.0 Gy with a range of 35.2 to 75.5 Gy, with added 30 Gy to the primary lesion in two patients. Six patients received TBI eombined with APRSCT, with 8 Gy in the TBI group. Chemotherapy, given before or during after radiotherapy or alone, eonsisted of 2-6 cyeles of COP, COPP, COMP, CHOP or COBDP. Prognostie faetors were analyzed with Cox model. Results The local eontrol rate was 12%, 69%, 76% and 83% in ehemotherapy alone, radiotherapy alone, ehemotherapy plus radiotherapy and APRSCT eombined with TBI, respectively（ P = 0.057） .The 5-year survival rate was 9% ,52% ,63% and 83% ,respectively（ P = 0.032）. Multifaetor analysis showed that tumor extension and treatment methods were the most important prognostie faetors besides Ann-Arbor stage, but gender, pathology, age and symptoms had little effect on prognosis . Conclusions Chemotherapy plus radiotherapy group achieves a better survival rate than radiotherapy alone. It is helpful to evaluate prognosis to make more detail subareas on basis of local extensions in Ann Arbor staging system. For some NNHL patients with good financial condition, APBSCT combined with TBI is a good choice.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2006年第3期168-172,共5页
Chinese Journal of Radiation Oncology
关键词
非霍杰金淋巴瘤/放射疗法
非霍杰金淋巴瘤/化学疗法
自体外周血干细胞移植
全身放射疗法
预后
鼻腔
Non-Hodgkin＇s lymphoma/radiotherapy
Non-Hodgkin＇ s lymphoma/chemotherapy
Autologous peripheral blood stem cell transplantation
Total body irradiation
Prognosis
Nasal cavity
