原发睾丸非霍奇金淋巴瘤26例临床分析

目的：探讨原发睾丸非霍奇金淋巴瘤(non-Hodgidn’s lymphoma,NHL)的临床特点、治疗方法。方法：收集我院1980年10月至2002年2月收治的睾丸NHL26例,Ann Arbor分期ⅠE期17例,ⅡE期6例,ⅣE期3例。全部手术治疗。首程术后化疗24例,以CHOP方案为主,3～6周期,化疗加放疗9例,其中对盆腔／腹主动脉旁／阴囊等区域进行预防性放疗7例,针对病灶区放疗2例。阴囊区用9～12M eV电子线,其余用6～8MV-X线照射。照射剂量范围在36～50Gy,预防照射的平均剂量为40Gy。单纯手术和手术加放疗各1例。结果：全组一、三、五年总体生存率和无进展生存率分别为96．0％、78．1％、52．0％和70．2％、55．3％、49．2％。总失败率为53．8％,其中对侧睾丸、中枢神经系统受侵率分别为15．4％、11．5％,腹膜后淋巴转移率19．2％。结论：睾丸NHL一般为中-高度恶性,结外器官和淋巴结受侵率高,睾丸和腹膜后区分别占结外器官和淋巴结受侵的首位。所有期别的睾丸NHL都应化疗。ⅠE、ⅡE期病例应常规行腹主动脉旁、同侧髂血管旁和阴囊区预防性照射。ⅢE、ⅣE期以化疗为主,残留病灶辅以局部放疗。

Analysis of 26 cases of primary testicular non-Hodgkin's lymphoma

Purpose: To investigate the clinical features and treatment options of primary testicular non-Hodgkin "s lymphoma( NHL). Methods: From October 1980 to February 2002 , 26 patients with Ann Arbor stage I E( n = 17), II E( n = 6), IVE( n.= 3) primary testicular NHL were treated by Orchidectomy . Twenty-four patients received chemotherapy of CHOP regimen for 3-6 cycles and 9 patients were treated by chemotherapy plus radiotherapy as the primary treatment . 1 case by surgery alone and another by surgery and postoperative radiotherapy. The doses of irradiation ranged from 36 to 50Gy, of which 36-40Gy for prophylactic purpose and 45-50 Gy for residual lesions. Results: The 1, 3, 5-years overall survival and progress-free survival rates were 96. 0% , 78. 1% , 52. 0% and 70. 2% , 55. 3% , 49. 2% respectively. ?The overall relapse rat was 53. 8%. The involved rates of contralateral testis, central nervous system were 15. 4% , 11. 5% respectively and 19. 2% for retroperitoneal lymph nodes. Conclusions: Primary testicular NHL is essentially an intermediate or high grade lymphoma and has a high rate of incidence of lymph nodes and extranodal recurrence . Chemotherapy should be given to patients of all stages. For cases with stage I E and II E, prophylatic radiotherapy to para-aortic and illiac and scrotum is necessary. Radiotherapy is an important adjuvant modality therapy to stages Dip and IV E patients.