改良CHOP方案联合放疗治疗早期侵袭性头颈部非霍奇金淋巴瘤的初步研究

Pilot study of modified version of CHOP plus radiotherapy for early-stage aggressive non-Hodgkin's lymphoma of the head and neck.

作者信息

Nishioka Takeshi, Tsuchiya Kazuhiko, Nishioka Seiko, Kitahara Toshihiro, Ohmori Keiichi, Homma Akihiro, Aoyma Hidefumi, Shindoh Masanobu, Shirato Hiroki

机构信息

Department of Radiology, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8648, Japan.

出版信息

Int J Radiat Oncol Biol Phys. 2004 Nov 1;60(3):847-52. doi: 10.1016/j.ijrobp.2004.04.034.

DOI:10.1016/j.ijrobp.2004.04.034

PMID:15465202

Abstract

PURPOSE

To evaluate the safety and efficacy of a modified version of cyclophosphamide, doxorubicin, vincristine, prednisone (pirarubicin, cyclophosphamide, vincristine, and prednisone [THP-COP]) plus radiotherapy for early-stage aggressive non-Hodgkin's lymphoma of the head and neck.

METHODS AND MATERIALS

Between December 1993 and December 1999, 41 patients with early-stage non-Hodgkin's lymphoma with intermediate-grade histologic features were enrolled in our study. The mean patient age was 51 years. Of the 41 patients, 27 had Stage I and 14 Stage II disease. The primary site was Waldeyer's ring, a neck node, or an extranodal site in 14, 11, and 16 patients, respectively. The immunophenotype was B cell in 29 and T cell in 12 patients. All patients were in the low-risk category according to the International Prognostic Index. Chemotherapy consisted of 40 mg/m(2) i.v. pirarubicin (THP-Adriamycin), 750 mg/m(2) i.v. cyclophosphamide, and 1.0 mg/m(2) i.v. vincristine, on Day 1 and 40 mg/m(2) p.o. prednisone on Days 1-5. The combination chemotherapy was given twice at a 14-day interval. Radiotherapy was given to involved areas at a fraction size of 2.0-2.5 Gy up to a total of 40 Gy within 4-5 weeks. The mean follow-up period was 63 months.

RESULTS

The 5-year overall survival rate was 89%. The 5-year cause-specific survival and progression-free survival rate was 90% and 81%, respectively. The 5-year progression-free survival rate for patients with Waldeyer's ring primaries was 93%. Patients with tumor <5 cm in size had greater 5-year progression-free survival than those with tumor >5 cm in size (85% vs. 33%, p <0.05, log-rank test). Grade 4 neutropenia was seen in 12% of patients; however, 93% of patients (38 of 41) received chemotherapy as scheduled with the support of granulocyte colony-stimulating factor.

CONCLUSION

Biweekly THP-COP plus radiotherapy is feasible and effective for Stage I-II low-risk non-Hodgkin's lymphoma.

摘要

目的

评估改良版环磷酰胺、阿霉素、长春新碱、泼尼松（吡柔比星、环磷酰胺、长春新碱和泼尼松[THP-COP]）联合放疗治疗早期侵袭性头颈部非霍奇金淋巴瘤的安全性和有效性。

方法和材料

1993年12月至1999年12月期间，41例具有中级组织学特征的早期非霍奇金淋巴瘤患者纳入本研究。患者平均年龄为51岁。41例患者中，27例为I期，14例为II期。原发部位分别为瓦尔代尔环、颈部淋巴结或结外部位的患者有14例、11例和16例。免疫表型为B细胞的患者有29例，T细胞的患者有12例。根据国际预后指数，所有患者均属于低风险类别。化疗方案为第1天静脉注射40mg/m²吡柔比星（THP-阿霉素）、750mg/m²环磷酰胺和1.0mg/m²长春新碱，第1 - 5天口服40mg/m²泼尼松。联合化疗每14天进行一次，共进行两次。对受累区域进行放疗，每次分割剂量为2.0 - 2.5Gy，在4 - 5周内总剂量达40Gy。平均随访期为63个月。

结果

5年总生存率为89%。5年病因特异性生存率和无进展生存率分别为90%和81%。瓦尔代尔环原发性肿瘤患者的5年无进展生存率为93%。肿瘤大小<5cm的患者5年无进展生存率高于肿瘤大小>5cm的患者（85%对33%，p<0.05，对数秩检验）。12%的患者出现4级中性粒细胞减少；然而，93%的患者（41例中的38例）在粒细胞集落刺激因子的支持下按计划接受了化疗。