Mohammadianpanah Mohammad, Omidvai Shapour, Mosalei Ahmad, Ahmadloo Niloofar
Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Fars, Iran (Islamic Republic).
Ann Hematol. 2005 Apr;84(4):223-6. doi: 10.1007/s00277-004-0860-0. Epub 2004 Mar 23.
Primary extranodal non-Hodgkin's lymphomas of the head and neck account for 10-20% of all non-Hodgkin's lymphomas. Primary tonsillar lymphoma accounts for less than 1% of head and neck malignancies, although the tonsil is the most common primary extranodal site of head and neck non-Hodgkin's lymphomas. In this study we analyzed our cases of tonsillar lymphoma treated in our institution during the last 10 years to compare the finding of this study with those of previous studies. We reviewed the cases of tonsillar lymphoma treated in the Radiation Oncology Department of Shiraz University from 1992 to 2002. Clinical data were obtained from patients' files. The patients were treated by combined chemotherapy [a median of six cycles of a CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisolone)] and radiation therapy (40-50 Gy to the primary site and neck). Chemotherapy mainly preceded radiotherapy, although the sequence of radiotherapy and chemotherapy was determined by individual physicians and patients' choice. Surgery was used mainly to establish the diagnosis, and tonsillectomy was performed for localized small lesions. Between 1992 and 2002, 19 patients with stage IE (10), IIE (7), and IIIE (2) disease were treated. Median and mean age was 48 and 44 years (range: 22-76 years), respectively, at the time of diagnosis, with a male to female ratio of 1.2:1. The vast majority of patients presented in early stages with aggressive histology. High-grade tumors seemed to affect mainly young people (p=0.226). Diffuse large B-cell lymphomas were the most prevalent. Male patients were significantly younger than females (p=0.021). The patients were treated by combined chemotherapy and radiation therapy. All patients achieved and maintained complete remission with a median of 60 months relapse-free survival and a 5-year cause-specific survival rate of 100%. All patients developed some degree of oropharyngeal mucositis. Three patients (16%) experienced grade 3 or 4 neutropenia. Mild (grade I) xerostomia remained persistently in four patients (21%). A late fatal side effect was observed in one patient who developed radiation-induced sarcoma 7 years after initial diagnosis and died 8 months later without evidence of recurrent lymphoma. Complete follow-up was obtained in all patients. The follow-up period ranged from 18 to 141 months with a median of 60 and a mean of 60.4 months. At the time of last follow-up, all patients but one were alive. Age, sex, stage, bulk of disease, performance status, number of chemotherapy cycles, number of involved sites, histologic subtypes, and radiation dose were analyzed as prognostically significant for disease-specific survival in our cases. Significant prognostic factors were not identified by multivariate analysis. Combined chemotherapy and radiation therapy is safe, highly effective, and probably curative for most patients with primary tonsillar lymphoma.
头颈部原发性结外非霍奇金淋巴瘤占所有非霍奇金淋巴瘤的10% - 20%。原发性扁桃体淋巴瘤占头颈部恶性肿瘤的比例不到1%，尽管扁桃体是头颈部非霍奇金淋巴瘤最常见的原发性结外部位。在本研究中，我们分析了过去10年在我们机构治疗的扁桃体淋巴瘤病例，以将本研究结果与既往研究结果进行比较。我们回顾了1992年至2002年在设拉子大学放射肿瘤科接受治疗的扁桃体淋巴瘤病例。临床数据来自患者病历。患者接受联合化疗[CHOP方案（环磷酰胺、阿霉素、长春新碱和泼尼松龙）中位6个周期]和放射治疗（原发部位和颈部40 - 50 Gy）。化疗主要先于放疗，不过放疗和化疗的顺序由个别医生和患者选择决定。手术主要用于明确诊断，对于局限性小病变行扁桃体切除术。1992年至2002年期间，19例IE期（10例）、IIE期（7例）和IIIE期（2例）患者接受了治疗。诊断时的中位年龄和平均年龄分别为48岁和44岁（范围：22 - 76岁），男女比例为1.2:1。绝大多数患者以侵袭性组织学表现为早期发病。高级别肿瘤似乎主要影响年轻人（p = 0.226）。弥漫性大B细胞淋巴瘤最为常见。男性患者明显比女性年轻（p = 0.021）。患者接受联合化疗和放射治疗。所有患者均实现并维持完全缓解，中位无复发生存期为60个月，5年疾病特异性生存率为100%。所有患者均出现了一定程度的口咽粘膜炎。3例患者（16%）出现3级或4级中性粒细胞减少。4例患者（21%）持续存在轻度（I级）口干。1例患者在初始诊断7年后发生放射性肉瘤，8个月后死亡，无淋巴瘤复发证据，观察到一种晚期致命副作用。所有患者均获得了完整随访。随访期为18至141个月，中位时间为60个月，平均为60.4个月。在最后一次随访时，除1例患者外所有患者均存活。我们分析了年龄、性别、分期、疾病体积、体能状态、化疗周期数、受累部位数、组织学亚型和放射剂量对我们病例中疾病特异性生存的预后意义。多因素分析未发现显著的预后因素。联合化疗和放射治疗对大多数原发性扁桃体淋巴瘤患者安全、高效，可能具有治愈性。
