鼻腔非霍奇金淋巴瘤70例

摘要

Objective To analyze the initial response rate of radiotherapy and chemotherapy,and the influence of different treatment modalities on pmgnnsis of primary non-Hodgkin lymphoma(NHL)of the nascl cavity.Methods From January 1993 to December 2002,70 patients were confirmed by histopathology as NHL,including 52 T cell origin,2 B cell and 16 NK cell.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 cervical area was first used when there was invasion of the oropharynx.The median dose to the nasal cavity wag 54.0 Gy with a range of 336 to 66 Gy,given before or during after radiotherapy or alone,consisted of 2-6 cycles chemotherapy of COP,CHOP or COBDP.Prognostic factors were analyzed with Cox model. Results The local control rates was 12.5%, 66.7% and 74.0% in chemotherapy alone,radiotherapy alone,and chemotherapy plus radiotherapy.The 5-year survival rate Wag 12.5%,50.0% and 62.0%,respectively(P＜0.05).Multifaetor analysis showed that tumor extension and treatment methods were the most important prognostic factors besides Ann-Arbor stage,but gender,pathology,age and symptoms had little effect on prognosis.Conclusion Chemotherapy plus radiotherapy group achieved a better survival rate than radiotherapy alone.For some NHL patients with good financial condition,APBSCT is a good choice.%目的 评价原发鼻腔非霍奇金淋巴瘤(NHL)放疗和化疗的近期疗效,并对影响预后的因素进行分析.方法 1993年1月至2002年12月收治的原发鼻腔NHL 70例伞部经病理证实,其中T细胞来源52例,B细胞来源2例,NK/T细胞来源16例.放疗主野为鼻前凸字形野,辅单或双侧耳前野,累及口咽者先用面颈联合野,放疗采用60Co或直线加速器常规放射,2 Gy/次.鼻腔靶区中位剂量54 Gv(36～66 Gy).辅助化疗在放疗前、中、后进行或单纯化疗,方案为COP、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、放加化组局部控制率分别为12.5%、66.7%、74.0%,5年总生存率分别为12.5%、50.0%、62.0%(P＜0.05).首程治疗后的CR率是独立的预后因素,除AnnArbor分期外,局部侵犯范围、发热、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 放化疗联合治疗原发鼻腔NHL的生存率优于单纯放疗和单纯化疗.对于原发鼻腔NHL的治疗有条件者可试用自体干细胞移植.