鼻腔非霍奇金淋巴瘤的化学治疗及放射治疗

目的 探讨不同治疗方法对鼻腔非霍奇金淋巴瘤(NHL)患者的预后影响。方法 在59例原发于鼻腔NHLIE期患者中,化疗 放疗33例,放疗 化疗8例,单纯化疗10例,单纯放疗8例,化疗方案为CHOP.结果 全组患者的l,3,5年生存率分别为71．2％、42．0％和38．5％,不同治疗方法的生存率差异无显著性(P=0．3943),但生存曲线显示,放化组优于其他组。临床分期显示,Ig局限组患者l,3,5年生存率为84．2c／／,67．7％和62．0%,,Ig超腔组患者为50．0％、14．3％和14．3％,差异有显著性(P=0．0012)。首程化疗≥3个周期24例,首程放疗≥40 Gy16例,CR率分别为25．0v／／,和75．0％,筹异有显著性(P=0．002)。首程化疗2,3～4,5～6个周期的CR率分别为10．5％、25．0％和25．0％,差异无显著性(P=0．48)。并发症发生率及治疗相关死亡率均以化放组为高(39．4％,15．2％),但差异无显著性(P=0．202,P=0．693)。结论 Ⅰ期鼻腔NHL患者首选放疗,以尽早达到局部控制,再根据临床分期及恶性程度或国际预后指数(IPI)酌情给予更有效的化疗方案。

Chemotherapy and radiotherapy for non-Hodgkin's lymphomas of the nasal cavity

OBJECTIVE: To investigate the effects of different treatments on the prognosis of patients with non-Hodgkin's lymphomas of the nasal cavity. METHODS: A retrospective study of 59 patients who suffered from stage I(E) primary non-Hodgkin's lymphomas of the nasal cavity was presented. They were treated by radiotherapy and chemotherapy of CHOP regimen, in which 33 patients received chemotherapy plus radiotherapy, 8 patients received radiotherapy plus chemotherapy, 10 patients received chemotherapy alone, and 8 patients received radiotherapy alone. Survival analysis was performed by Kaplan-Meier method, the difference between groups was evaluated by log-rank test, and the comparison of rates was carried out by chi(2) test. RESULTS: The overall 1-, 3- and 5-year survival rates were 71.2%, 42.0% and 38.5%, respectively. There was no significant difference among the patients received different treatments (chi(2) = 2.98, P = 0.3943), but the patients received radiotherapy plus chemotherapy seemed to have a better survival curve than other patients. The 1-, 3- and 5-year survival rates were 84.2%, 67.7% and 62.0% for lesion limited in nasal cavity but 50.0%, 14.3% and 14.3% for lesion extended and involved the adjacent structures (chi(2) = 10.46, P = 0.0012). As the initial therapy, 24 patients who received chemotherapy of more than 3 cycles, and 16 patients who received radiotherapy of more than 40 Gy, and the complete response (CR) rates were 25.0% and 75.0% (chi(2) = 9.697, P = 0.002). Among 43 patients received chemotherapy, the CR rates for those who received 2, 3 - 4 and 5 - 6 cycles were 10.5%, 25.0% and 25.0%, respectively (chi(2) = 1.467, P = 0.48). Patients who received chemotherapy plus radiotherapy have higher rates of both complication and treatment-related mortality, but the difference was not statistically significant (P = 0.202 and 0.693). CONCLUSION: For stage I non-Hodgkin's lymphomas of the nasal cavity, radiotherapy should be the first treatment to get early local control. Chemotherapy may be followed at the discretion of the pathological grade and clinical staging, or IPI.