Johnson R E, DeVita V T, Kun L E, Chabner B R, Chretien P B, Berard C W, Johnson S K
Br J Cancer Suppl. 1975 Mar;2:237-41.
Decision making in cancer therapy has traditionally evolved through careful observation of the clinical course subsequent to various treatment approaches. This method has also served to delineate the wide spectrum of primary manifestations and patterns of biological behaviour characterizing the malignant lymphomata. Marked disparity has been consistently appreciated between the natural history of lymphomata originating in lymph nodes in contrast to those primary in extranodal sites. The former are usually anatomically generalized at diagnosis whereas primary extranodal lymphomata are commonly localized and more closely resemble carcinomata of the respective organs with their propensity for both regional lymphatic extension and haematogenous spread. Prospective staging of 100 consecutive patients with previously untreated malignant lymphoma has been consistent with this past experience in demonstrating the presence of disseminated involvement in the majority of patients. It has also become apparent that reliance upon either clinical or surgical staging of disease extent is often misleading since widespread disease frequently develops even in those patients staged as having localized involvement and thereby treated with local irradiation. High dose, wide field lymphatic irradiation "á la Hodgkin's disease" seldom constitutes appropriate treatment for patients having lymph node presentations of lymphoma. There is rather a need to recognize the importance of systemic treatment for most cases, negating the utility of routine exhaustive staging since treatment decisions can be based upon readily assessed clinicohistological determinants in the majority of cases.
传统上，癌症治疗中的决策是通过仔细观察各种治疗方法后的临床病程而逐渐形成的。这种方法也有助于描绘出恶性淋巴瘤的广泛的主要表现和生物学行为模式。人们一直认识到，起源于淋巴结的淋巴瘤的自然病程与结外部位原发性淋巴瘤的自然病程存在明显差异。前者在诊断时通常在解剖学上已广泛播散，而原发性结外淋巴瘤通常局限，更类似于相应器官的癌，具有区域淋巴扩散和血行播散的倾向。对100例未经治疗的恶性淋巴瘤患者进行的前瞻性分期与过去的经验一致，表明大多数患者存在播散性受累。同样明显的是，依赖临床或手术分期来确定疾病范围往往会产生误导，因为即使在那些被分期为局限性受累并因此接受局部放疗的患者中，也经常会出现广泛的疾病。对有淋巴瘤淋巴结表现的患者，高剂量、大范围的淋巴照射“如霍奇金病那样”很少构成合适的治疗方法。相反，有必要认识到大多数病例全身治疗的重要性，否定常规详尽分期的作用，因为在大多数情况下，治疗决策可以基于易于评估的临床组织学决定因素。
