不同方法治疗子宫内膜癌的疗效分析

目的　分析不同方法治疗子宫内膜癌的疗效。方法　将 3 3 6例分别给予 4种不同的治疗方法 :①单纯手术 (手术组 ) 95例 ;②手术 +放疗 (放疗、手术 +放疗组 ) 10 5例 ;③单纯放疗 (放疗组 ) 5 5例 ;④化疗 +孕激素 (化疗组 ) 81例。治疗后均随访 5年以上 ,观察各组 5年生存率。结果　手术组病理分期 ,放化疗组为临床分期。Ⅰ、Ⅱ及Ⅲ～Ⅳ期 5年生存率 :手术组分别为 78%、60 %及17 3 % ;手术 +放疗组为 73 %、5 9 5 %及 5 0 % ;放疗组分别为 3 7 5 %、18%及 0 % ;化疗 +孕激素组分别为 3 7 5 %、17 6%及 5 %。Ⅰ、Ⅱ期 5年生存率手术组与手术 +放疗组相比差异无显著性 (P >0 0 5 ) ,而Ⅲ～Ⅳ期手术 +放疗组明显高于手术组 (P <0 0 0 1)。单纯放疗组与化疗 +孕激素组相比Ⅰ、Ⅱ期无显著差异 (P >0 0 5 ) ,而Ⅲ～Ⅳ期化疗 +孕激素组稍高于单纯放疗组。结论　子宫内膜癌中早期尽量手术治疗 ,术后辅助放疗效果最佳。对放疗和化疗组适于Ⅲ～Ⅳ期、多有合并症及手术禁忌症者     

子宫腺肉瘤的临床病理分析

目的探讨子宫腺肉瘤的临床病理学特征、诊断、治疗及预后。方法回顾性分析中国医学科学院肿瘤医院自2001年～2013年收治的13例子宫腺肉瘤患者的临床病理资料及随访结果。结果患者年龄36～71岁,平均54岁。主要表现为异常阴道出血,特征性病理表现为肿瘤间质＂套袖样＂或息肉样突入腺腔内。13例患者均接受手术治疗,9例术后行辅助化疗,3例行放疗。随诊期间1例Ⅳ期患者因化疗无效于术后1个月死亡;3例患者于初始治疗后数月内死于肿瘤复发、转移,另外9例患者随访至今无复发。结论子宫腺肉瘤临床罕见,无特异性临床表现,确诊依赖于术后病理学检查;临床呈低度恶性,治疗应采用手术为主的综合治疗,晚期及存在高危因素的患者预后不良。疾病易复发,应长期随诊。     

44例儿童青少年恶性生殖细胞肿瘤综合治疗结果分析

背景与目的:目前儿童青少年恶性生殖细胞瘤采用综合治疗,总生存率已达75%以上,然而,不同分期、病理类型和发病部位的患者有不同的预后。本文分析儿童青少年恶性生殖细胞瘤的临床特点、综合治疗的效果和影响预后的因素,并探讨其治疗策略。方法:对1997年1月～2005年12月中山大学肿瘤防治中心收治的儿童青少年恶性生殖系统肿瘤患者的临床表现、综合治疗疗效和不良预后因素进行分析;采用Kaplan-Meier法计算全组生存率。结果:44例患者中,25例行术后辅助化疗;1例单纯手术;18例行诱导化疗,其中7例患者化疗后肿瘤缩小行手术切除,2例原发纵隔绒癌伴多发转移患者化疗后行残留病灶放疗,1例术后腹腔转移和1例术后肺转移患者化疗后获得完全缓解,1例原发纵隔内胚窦瘤化疗后部分缓解,未做进一步治疗,6例患者化疗无效进展死亡。化疗的患者均采用含铂类化疗方案治疗2～7个疗程。中位随访时间32个月,全组3年总生存率为84.8%;Ⅰ Ⅱ期患者3年生存率为100%,Ⅲ期为83.3%,Ⅳ期为65.6%,复发患者为66.7%;初治生殖器内(睾丸和卵巢)肿瘤患者3年生存率为96.0%,生殖器以外肿瘤患者为61.0%。结论:手术联合含铂类药物化疗能明显改善儿童青少年生殖细胞瘤的疗效和生存率,但对Ⅳ期、复发转移和生殖器以外的生殖细胞瘤患者应探讨新的方案和增加剂量强度。     

神经母细胞瘤37例临床分析

背景与目的:神经母细胞瘤是儿童的常见肿瘤,预后差。本研究探讨神经母细胞瘤(neuroblastoma,NB)的临床特征、治疗方法及预后。方法:对1998年6月至2007年11月中山大学肿瘤防治中心收治的37例神经母细胞瘤患者的临床表现、治疗方法、治疗疗效及不良预后因素进行分析;采用Kaplan-Meier法计算全组生存率,组间比较用log-rank检验,并采用Cox模型进行多因素分析。结果:37例患者中男女比例为2.7∶1,中位年龄4岁;常见原发部位为腹膜后及肾上腺(78.4%)、纵隔(16.2%)、颈部(2.7%)、盆腔(2.7%);常见首发症状为发热(54.0%)、发现肿块(48.6%)、局部疼痛(45.9%);临床分期:Ⅱa期(5.4%)、Ⅱb期(2.7%)、Ⅲ期(24.3%)、Ⅳ期(67.6%);全组患者中19例行综合治疗,其中8例行手术+化疗+放疗,10例行手术+化疗,1例行化疗+放疗;全组1年、2年及5年总生存率分别为66%、40%及11%。单因素分析显示,综合治疗、手术方式、放疗、化疗疗程数(≥7疗程)及血清LDH(>800U/L)为影响预后的因素。Cox回归模型多因素分析显示化疗疗程数(≥7疗程)及血清LDH(>800U/L)为独立的预后因素。结论:NB临床上应采取以手术、化疗和放疗为主的综合治疗,增加化疗疗程数可以提高NB患者总的生存率,并改善其预后;检测血清LDH对估计NB患者预后进而指导治疗具有重要意义。     

46例原发性阴道癌临床分析

目的 :探讨原发性阴道癌临床治疗方法及失败原因。方法 :本组 4 6例患者 ,单纯放疗 2 7例 ,手术 8例 ,采用放疗同时辅以PDD为主的全身化疗 11例。结果 :总的 5年生存率为 5 4 3% ,各期 5年生存率分别为Ⅰ期 90 90 %、Ⅱ期6 8 4 2 %、Ⅲ期 2 2 2 2 %、Ⅳ期 0 %。Ⅰ～Ⅱ期早期患者与Ⅲ～Ⅳ期晚期患者 5年生存率分别为 76 6 7%及 12 5 % (P <0 0 5 )。Ⅰ～Ⅱ期早期患者中单纯放疗或加化疗与手术治疗相比 ,5年生存率分别为 86 36 %和 5 0 0 % (P >0 0 5 )。Ⅲ～Ⅳ期晚期患者中单纯放疗及放疗加化疗 5年生存率分别为 0 %及 2 2 2 2 % (P >0 0 5 )。局部未控 8例患者 ,仅 1例为Ⅱ期 ;远处转移 5例全为Ⅲ～Ⅳ期晚期患者。结论 :早期阴道癌患者治疗失败原因为局部控制失败 ,有效控制局部可以获得好的预后 ,手术与放疗或加化疗疗效一样 ;而晚期患者同时控制远处转移是十分必要的 ,单纯放疗对晚期患者疗效不佳 ,联合化疗可以提高生存率。     

舌体鳞状细胞癌不同治疗模式疗效分析

目的 探讨舌体鳞癌患者不同治疗模式的治疗效果。方法 回顾分析2003—2011年间在本院首治的经病理确诊且随访资料完整的舌体鳞癌患者 132例临床资料。Kaplan-Meier法计算单纯手术(S)、单纯放疗(R)、手术+放疗(S+R)、化疗+手术(C+S)、化疗+放疗(C+R)、手术+放疗+化疗(S+R+C)各组OS,组间差异采用Logrank法检验。Cox回归模型多因素预后分析确立有影响的治疗模式。结果 3年随访率为100%。3年样本数为 94例。全组患者 3年OS为72.7%。单因素分析显示 70例Ⅰ+Ⅱ期患者中S、R、S+R、C+S、S+R+C的分别为86%、67%、97%、100%、82%(P=0.018),62例Ⅲ+Ⅳ期患者中S、R、S+R、C+S、C+R、S+R+C的分别为38%、14%、92%、40%、14%、67%(P=0.000)。多因素分析显示S+R、S+R+C是影响预后的因素(P=0.000、0.005)。结论 Ⅰ~Ⅱ期行手术或手术为主综合治疗疗效较好,Ⅲ~Ⅳ期行以手术为主综合治疗预后较好,其中S+R、S+R+C是较好的治疗模式,对中晚期病例行R、C+R预后差。     

原发乳腺非霍奇金淋巴瘤的临床分析

目的　分析原发乳腺非霍奇金淋巴瘤的临床特点、诊断、治疗及预后。方法　对 18例原发于乳腺的非霍奇金淋巴瘤进行分析 ,其中Ⅰ期 11例 ( 61.1% ) ,Ⅱ期 7例 ( 3 8.9% )。 1例 ( 5 .6% )为未分型NHL ,17例 ( 94.4% )为B细胞来源。 15例( 83 .3 % )先行手术治疗 ,术后 3例行放疗 ,7例行化疗 ,5例行放疗、化疗综合治疗。未手术的 3例均行放疗、化疗的综合治疗。结果　中位随访时间为 89个月 ,6例 ( 3 3 .3 % )出现局部复发或远处播散。总 3、5年生存率分别为 87.5 %和 71.5 % ,3、5年无进展生存率分别为 75 .6%和 68.1%。结论　对原发乳腺非霍奇金淋巴瘤 ,采用合理的放疗、化疗综合治疗可获得较好疗效 ;推荐以蒽环类药物为主的化疗方案     

妇科原发性小细胞癌八例临床分析

目的 妇科原发性小细胞癌病例罕见,预后差.结合北京大学第三医院病例探讨妇科原发性小细胞癌的发病特点以及诊断治疗方案.方法 回顾性分析2006 01-01-2015-08-31北京大学第三医院收治的经病理确诊的8例妇科原发性小细胞癌患者的临床特征、治疗方案以及预后.结果 患者年龄16～71岁,中位年龄43岁.常见症状包括阴道异常出血、腹痛、腹部包块等.诊断主要依靠手术病理确诊,其中宫颈小细胞癌ⅠB1期2例,ⅠB2期2例,ⅢB期1例;卵巢小细胞癌ⅢC期1例;子宫内膜小细胞癌Ⅳ期2例.治疗方案包括手术、化疗和放疗.手术方式参照相应部位肿瘤的治疗原则,有5例行广泛子宫切除术,2例行肿瘤细胞减灭术,1例因高龄伴高血压未行手术.7例手术患者中有3例接受术前化疗,7例术后均辅助化疗,有5例辅助术后放疗.随访至2015-12-20,无患者失访.有3例生存,分别随访22、22和56个月;5例死亡,生存期分别为2、8、10、22和31个月.患者疾病无进展生存时间(progression free survival,PFS)为0.3～56个月,中位PFS为1 5个月,总生存时间(overall survival,OS)为2～56个月,中位OS为22个月.结论 妇科小细胞癌术前影像学检查常有淋巴结转移,其确诊依靠组织病理学检查.该肿瘤预后差,手术是早期病变的主要治疗手段,晚期病例宜采用手术、化疗和放疗相结合的综合治疗.     

16例直肠小细胞癌临床治疗及预后分析

背景与目的:直肠小细胞癌恶性程度高,易发生早期转移,临床上罕见,预后较差。本研究分析直肠小细胞癌的临床特点,并总结其临床诊断、治疗方法及预后。方法:回顾性分析2000年1月—2013年1月郑州大学附属肿瘤医院收治的经病理证实的16例直肠小细胞癌患者的临床资料。结果:16例患者中,男性9例,女性7例,中位年龄58.5岁;TNM分期Ⅱ期4例,Ⅲ期7例,Ⅳ期5例。10例行手术治疗,其中6例行根治性手术,4例行姑息性手术,术后6例接受单纯化疗,2例接受放化疗,2例未接受任何治疗。5例诊断时失去手术机会,其中3例仅行化疗,2例行放化疗。1例未行任何治疗。10例手术切除的病灶中,5例有脉管浸润,7例有局部淋巴结转移。全组患者获得7~65个月的随访。中位生存期15.4个月。6个月、1年、2年、3年和5年生存率分别为58.4%、46.2%、26.6%、13.1%和6.2%。患者的预后与肿瘤的分期、有无脉管浸润、有无淋巴结转移和手术根治程度有关(P<0.05);而与年龄、性别和肿瘤的大小无关(P>0.05)。结论:直肠小细胞癌临床上罕见,其生物学行为与小细胞肺癌相似,病情进展迅速,预后较差,治疗方法以手术、放疗、化疗为主,总体疗效不佳。     

神经母细胞瘤37例临床分析

背景与目的：神经母细胞瘤是儿童的常见肿瘤,预后差。本研究探讨神经母细胞瘤（neuroblastoma,NB）的临床特征、治疗方法及预后。方法：对1998年6月至2007年11月中山大学肿瘤防治中心收治的37例神经母细胞瘤患者的临床表现、治疗方法、治疗疗效及不良预后因素进行分析;采用Kaplan—Meier法计算全组生存率,组间比较用log-rank检验．并采用Cox模型进行多因素分析。结果：37例患者中男女比例为2．7：1,中位年龄4岁;常见原发部位为腹膜后及肾上腺（78．4％）、纵隔（16．2％）、颈部（2．7％）、盆腔（2．7％）;常见首发症状为发热（54．O％）、发现肿块（48．6％）、局部疼痛（45．9％）;临床分期：Ⅱa期（5．锄）、1Ib期（2．7％）、Ⅲ期（24．3％）、Ⅳ期（67．6％）;全组患者中19例行综合治疗．其中8例行手术＋化疗＋放疗,10例行手术＋化疗,1例行化疗＋放疗;全组1年、2年及5年总生存率分别为66％、40％及11％。单因素分析显示,综合治疗、手术方式、放疗、化疗疗程数（≥7疗程）及血清LDH（〉800U／L）为影响预后的因素。Cox回归模型多因素分析显示化疗疗程数（〉／7疗程）及血清LDH（〉800U／L）为独立的预后因素。结论：NB临床上应采取以手术、化疗和放疗为主的综合治疗,增加化疗疗程数可以提高NB患者总的生存率．并改善其预后：检测血清LDH对估计NB患者预后进而指导治疗具有重要意义。     

Outcomes of primary thyroid non-Hodgkin’s Lymphoma

Primary non-Hodgkin’s lymphoma (NHL) of the thyroid gland is a rare disease with an incidence of 0.5 per 100,000 population. Stages IE and IIE thyroid NHL have been traditionally treated by surgical resection; however, modern treatment consists of chemotherapy and local radiotherapy, and surgery is often reserved for tissue diagnosis and relief of airway compression. We retrospectively reviewed the management and outcomes of nine consecutive patients with thyroid NHL, eight females and one male (median age 63 yr, range 34-71 yr) treated between 1994 and 1999. Five patients had disease stage IE and 4 stage IIE. Median follow-up was 72 mo. Pathohistology and immunohistochemistry identified two patients with mucosa-associated lymphoid tissue (MALT), three follicular center cell lymphoma (FCC), two patients large B-cell lymphoma (BLCL), one a marginal zone lymphoma (MZL), and one patient a peripheral T-cell lymphoma (PTCL). Total thyroidectomy was performed in three patients and subtotal thyroidectomy in four. One (MALT) patient underwent surgery alone; three patients surgery, radiotherapy, and chemotherapy (two FCC, one PTCL); three patients surgery and chemotherapy (one MALT, one FCC, one LBCL); and two chemotherapy alone (one LBCL, one MZL). Median survival was 79 mo (range 13–124 mo). The PTCL patient, a 34-yr-old man, died from disseminated disease at 13 mo despite secondary chemotherapy, and one LBCL patient with extensively invasive local disease died from stroke 17 mo after diagnosis. The remaining seven patients remain in remission with no local or systemic relapse at a mean of 86 mo. With appropriate therapy primary thyroid NHL has a favorable course; however, prognosis depends on the histology, local spread, and the stage of the disease at presentation, as well as the patient’s performance status. Surgery in combination with chemotherapy and/or radiotherapy is still warranted for intermediate and high-grade thyroid NHLs, with over 77% of patients achieving long-term remission. Peripheral T-cell lymphoma carries a poor prognosis.     

Multimodality treatment in anaplastic giant cell thyroid carcinoma

Anaplastic giant cell thyroid carcinoma is highly malignant. Surgery, chemotherapy, or radiotherapy used separately have not been effective. Combinations of the three modalities have been used at Radiumhemmet since the middle of the 1970s. Nine patients received three-drug chemotherapy and radiotherapy. One patient was alive after 12 years; eight died. Twenty-five patients were given a similar regimen (with two fractions of radiotherapy per day), aiming at surgery. Twelve patients could undergo surgery. Two were alive 11 and 3.5 years after diagnosis. One patient died free of tumor after 6.5 years. Of the remaining 22 patients, many died of metastatic disease. A combination of preoperative and postoperative radiotherapy, chemotherapy (bleomycin, cyclophosphamide, and 5-fluorouracil) and surgery during the remission has given a 12% (four of 34) survival (greater than 3 years). All survivors had undergone surgery. The patients who died had in many cases achieved local tumor control. Adriamycin (Adria Laboratories, Columbus, OH) once a week replaced BCF due to treatment complications in patients receiving BCF. Of five patients, only one was alive more than 10 months after treatment.     

107例非小细胞肺癌三维适形放疗或联合化疗的疗效及预后因素

目的观察非小细胞肺癌(NSCLC)应用三维适形放疗(3DCRT)或3DCRT联合化疗的疗效和安全性,并分析影响其预后的因素。方法将随访资料完整的107例NSCLC患者纳入分析,其中接受单纯3DCRT 26例,3DCRT联合化疗81例。3DCRT剂量2Gy/次,5次/周,中位DT 60Gy。评价近期疗效及毒副反应。应用Kaplan-Meier法和多因素Cox模型分析全组NSCLC患者的生存预后情况。结果全组患者获CR 10例(9.3%),PR 56例(52.3%),SD 30例(28.0%),PD 11例(10.4%),总有效率(RR)为61.7%(66/107)。随访14～62个月,中位随访27个月,随访率为96%。1、3、5年的生存率分别为67%、31%和22%,中位总生存时间(OS)为20.2个月。急性放射性肺炎2级3例,3级2例;晚期放射性肺炎2级1例,3级1例。急性放射性食管炎1级49例,2、3级9例。骨髓抑制1、2级32例,3、4级5例。单因素分析显示,临床分期、KPS评分、肿瘤体积、放疗剂量、治疗模式及近期疗效显著影响OS,而年龄、体重减轻及病理类型对OS无影响。Cox多因素分析显示,临床分期、治疗模式和近期疗效是影响预后的独立因素。结论 3DCRT联合化疗治疗NSCLC的近期疗效较好,毒副反应可耐受;临床分期、治疗模式和近期疗效可能是影响NSCLC预后的因素。     

嗅神经母细胞瘤综合治疗疗效及失败模式分析

目的 分析嗅神经母细胞瘤单中心的治疗疗效及失败模式。方法 回顾性分析本院1979—2014年间初诊112例无远处转移嗅神经母细胞瘤病例,改良Kadish分期A期1例、B期23例、C期60例、D期28例。手术+术后放疗±化疗者51例,放疗±化疗者46例,术前放疗+手术±化疗者11例,手术±化疗者3例,单纯化疗者1例。Kaplan-Meier法计算生存率。结果 全组5年样本数44例, 5年OS和DFS分别为66%和55%,术前放疗+手术±化疗者分别为91%和82%,手术+术后放疗±化疗者分别为80%和66%,放疗±化疗者分别为46%和37%。3例单纯手术均出现复发,1例姑息化疗者生存时间为6个月。全组共47例治疗失败,失败率为42%,以远处转移为首次失败方式者占总失败的53%、局部区域复发占36%、同时存在局部区域复发及远处转移者为11%。结论 嗅神经母细胞瘤治疗仍推荐放疗+手术综合治疗方案。综合治疗模式下嗅神经母细胞瘤局部区域控制率及疗效尚可,主要失败方式为远处转移。     

Results of multimodal therapy in Ewing's sarcoma: a retrospective analysis of 20 patients

A retrospective analysis was performed of 20 patients with Ewing's sarcoma treated by combined modality therapy, consisting of surgery, radiotherapy, and chemotherapy. Fourteen patients (70%) achieved complete remission and 5 patients (25%) were in partial remission at the end of treatment. One patient (5%) failed to respond to combined modality therapy. The overall 5 year actuarial survival was 64% and the disease free survival, 55%. Persistent or recurrent disease occurred in 8 patients (40%); one of them was salvaged by surgery and chemotherapy. Site and extent of primary lesion were prognosticators of patients' outcome. One patient developed radiation-related-sequelae. The efficacy of aggressive management consisting of wide surgery, radiotherapy and intermittent high dose chemotherapy is discussed.     

Juvenile granulosa cell tumor of the ovary in children: a clinical study of 15 cases

Juvenile granulosa cell tumor (JGCT) in children accounted for 12% of all ovarian tumors treated in the Institut Gustave-Roussy (IGR) Pediatric Department from 1967 to 1985. The median age of the 15 girls was 8 years 7 months (range, 22 months to 15 years 7 months). Precocious pseudopuberty was present in six of the seven girls under 8 years. Of the other seven girls, one developed virilization symptoms. Surgery was the first treatment in each case. According to the Wollner classification, there were six stage I, one stage II, six stage III (including four ruptured tumors), and one stage IV JGCT cases. One patient was not available for staging. An adjuvant treatment (five chemotherapy and one radiotherapy combined with chemotherapy) was administered to six patients. Eleven girls are alive and free of disease, with a median follow-up of 6 years (range, 2 to 18 years). Four girls relapsed 6 to 17 months after surgery and died. Two of these relapses occurred in bone. The prognosis for JGCT in children is favorable for the lower stages when treated with surgery, but the best treatment for extensive and recurrent disease has yet to be determined.     

Intérêt de la radiothérapie dans le traitement des lymphomes gastriques agressifs localisés

PurposeTo evaluate the treatment results of localised aggressive gastric lymphomas with favourable prognosis using chemotherapy and radiotherapy.Patients and methodsBetween February 1993 and December 2004, nine patients with primary gastric high-grade lymphoma have been treated by the Lymphoma Committee of Sfax (Tunisia). The sex ratio was 1.5. The mean age was 44.9 years. Histological type was the large cell B lymphoma in 100% of the cases. Disease was stage I in eight cases and stage II in one case (Ann Arbor Classification). The treatment consisted in primary chemotherapy followed by radiotherapy of the stomach with or without regional nodes (40 Gy).ResultsAfter treatment, all patients had complete remission. With a mean follow-up of 55.7 months, one patient was lost to follow-up; the other patients were alive with complete remission. No major acute toxicities or late effects were found. Overall survival was 100% at five years.ConclusionChemotherapy associated with radiotherapy can be proposed to patients having localised and aggressive primary gastric lymphoma with favourable prognosis, since this treatment is well tolerated and provides satisfactory control of the disease.     

Small cell carcinoma of the esophagus: the University of Texas M. D. Anderson Cancer Center experience and literature review

BACKGROUND: Small cell carcinoma of the esophagus is a rare disease with aggressive behavior and poor prognosis. Multidrug chemotherapy remains the treatment of choice given the systemic nature of the disease. Radiotherapy has been used concurrently with chemotherapy to enhance local control. The role of surgery in patients with limited disease is controversial. Limited data exist regarding the pathologic response of the tumor to chemoradiotherapy. The goal of the current study was to analyze the outcome of 8 patients treated at the M. D. Anderson Cancer Center, with particular focus on the histologic findings of the resected specimens. METHODS: Patient records were reviewed for demographics, presenting symptoms, diagnostic modalities, disease stage, treatment, and outcome. RESULTS: Two of eight patients had metastatic disease at the time of diagnosis and received combination chemotherapy. Six patients had limited stage disease. Four received combined modality treatment including esophagectomy, and two received radiotherapy only. All four patients who underwent esophagectomy had pure small cell carcinoma histology at diagnosis and received preoperative combination chemotherapy with or without radiotherapy. None of the four patients achieved a pathologic complete remission. Two patients had residual small cell carcinoma; one patient had squamous cell carcinoma and one adenocarcinoma. The median overall survival for the group of patients was 12.5 months (range, 5-57 months). CONCLUSIONS: In selected patients with limited stage disease, surgery with curative intent should be considered as part of multimodality treatment.     

Non-Hodgkin Lymphomas Presenting with Spinal Epidural Involvement

Spinal cord compression was the presenting symptom in 9 out of 299 previously undiagnosed non-Hodgkin lymphomas observed between 1972 and 1987. All patients had unfavourable histologic diagnosis and 4 had stage IE, 2 stage IIE and 2 were staged as IV; one patient did not undergo a staging procedure. All patients were treated with surgery and radiotherapy, whereas chemotherapy was employed in 3 cases only. Only 2 patients are still alive and disease-free after 3 and 8 years respectively; the remaining 7 died with progression of disease, even if in 2 cases a complete clinical remission was obtained. the recent literature has been reviewed. Non-Hodgkin lymphoma with spinal epidural presentation is usually an aggressive disease. An intensive treatment combining surgery, radiotherapy and chemotherapy is finally suggested to achieve better local and long-term results. Surgery can as a rule be limited to laminectomy plus biopsy.     

改良BFM-90方案明显改善儿童青少年淋巴母细胞型淋巴瘤的疗效

目的探讨改良BFM-90方案治疗儿童青少年淋巴母细胞型淋巴瘤的疗效,分析其不良反应和生存率。方法收集36例3～18岁初治的淋巴母细胞型淋巴瘤患者入组,Ⅱ期1例,Ⅲ期9例,Ⅳ期26例。28例(77.7%)为T细胞表型,26例(72.2%)患者有纵隔肿块,21例(58.3%)有骨髓侵犯。全部患者采用改良的BFM-90方案化疗,其方案包括诱导缓解、中枢神经系统预防、再诱导缓解和维持治疗,总疗程2年。此方案与标准的BFM-90方案不同之处是不做头颅预防照射,但维持治疗期间定期大剂量甲氨蝶呤(HD-MTX)静脉输注和鞘内注射。结果32例(88。8%)患者获得完全缓解(CR),1例(2.7%)部分缓解(PR),总有效率90.7%。1例进展(PD)。2例患者在第1次完全缓解后(CR1)行自体造血干细胞移植(APBSCT),2例患者行纵隔放疗。复发5例,其中2例挽救治疗后存活,另3例肿瘤进展死亡;诱导期死亡2例,1例死于真菌败血症,另1例死于脑出血。PR和PD2例患者均死于肿瘤进展;共7例患者死亡。中位随访时间28个月,3年总生存率为78.3%。主要的毒性反应是骨髓抑制、感染和出血等,需要积极处理。结论改良BFM-90方案可明显改善儿童青少年淋巴母细胞型淋巴瘤的疗效和生存率,主要不良反应为骨髓抑制,应在有经验的肿瘤中心或血液科中应用。