Goldwein J W, Coia L R, Hanks G E
Fox Chase Cancer Center, Department of Radiation Oncology, Philadelphia, PA 19111.
Int J Radiat Oncol Biol Phys. 1991 Jan;20(1):45-51. doi: 10.1016/0360-3016(91)90136-r.
Between 1974 and 1989, 58 patients with clinical Stages I and II non-Hodgkin's lymphomas of the head and neck were treated with radiation at the Fox Chase Cancer Center. Forty-one treated with radiotherapy alone form the basis for this retrospective analysis of outcome and prognostic factors. With a mean radiation dose of 4400 cGy, the 5-year actuarial local control rate is 92%. Only one patient failed within an irradiated field. The 5-year actuarial survival and relapse-free survival rates are 85% and 54%, respectively. In a univariate analysis, poor survival was significantly correlated with involvement of Waldeyer's ring, postoperative tumor size greater than 3 cm, and greater than two involved lymph nodes and extranodal sites (p less than 0.02). No such correlations were seen for stage, histologic grade, the presence of extranodal disease, or any of the other parameters that were examined. Relapse free survival was significantly correlated only with the total of the number of involved nodes and extranodal sites. Patients with one or two involved nodes and sites had a 68% chance of remaining disease-free at 5 years compared to 0% for patients with greater than two (p = .02). Again, significant trends were not seen for the other parameters analyzed. These data demonstrate excellent local control, survival, and relapse-free survival using radiation alone with doses of 3000-5000 cGy. In our group of clinically staged patients preselected for treatment with radiation alone, the total of the number of involved nodes and extranodal sites, involvement of Waldeyer's ring, and tumor size after resection correlated strongly with relapse-free survival and overall survival. In patients with early stage non-Hodgkin's lymphomas of the head and neck, initial management with external beam radiotherapy should be considered in particular for those with one or two involved nodes and extranodal sites that are less than 3 cm following resection and that do not involve Waldeyer's ring.
1974年至1989年间，福克斯蔡斯癌症中心对58例临床I期和II期头颈部非霍奇金淋巴瘤患者进行了放射治疗。其中41例仅接受放射治疗，构成了本次结局和预后因素回顾性分析的基础。平均放射剂量为4400 cGy，5年精算局部控制率为92%。仅1例患者在照射野内出现复发。5年精算生存率和无复发生存率分别为85%和54%。单因素分析显示，生存不良与韦氏环受累、术后肿瘤大小大于3 cm、两个以上受累淋巴结和结外部位显著相关（p<0.02）。对于分期、组织学分级、结外疾病的存在或所检查的任何其他参数，未发现此类相关性。无复发生存仅与受累淋巴结和结外部位的总数显著相关。有1或2个受累淋巴结和部位的患者5年无病生存率为68%，而有两个以上受累淋巴结和部位的患者为0%（p = 0.02）。同样，对于所分析的其他参数未发现显著趋势。这些数据表明，单独使用3000 - 5000 cGy的放射剂量可实现出色的局部控制、生存和无复发生存率。在我们这组预先选择仅接受放射治疗的临床分期患者中，受累淋巴结和结外部位的总数、韦氏环受累情况以及切除术后的肿瘤大小与无复发生存率和总生存率密切相关。对于早期头颈部非霍奇金淋巴瘤患者，尤其是那些切除术后有1或2个受累淋巴结和结外部位且小于3 cm且未累及韦氏环的患者，应考虑采用外照射放疗进行初始治疗。
