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[非霍奇金淋巴瘤]

[Non-hodgkin's lymphomas].

作者信息

Drouet F, Cahu X, Pointreau Y, Denis F, Mahé M-A

机构信息

Service de radiothérapie du centre rené-gauducheau, CRLCC Nantes-Atlantique, Boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France.

出版信息

Cancer Radiother. 2010 Nov;14 Suppl 1:S210-29. doi: 10.1016/S1278-3218(10)70025-1.

Abstract

With approximately 10000 cases per year in France, non-Hodgkin's lymphoma (NHL) represents the most frequent hematological malignancy, and 5 to 10 % of new cases of cancers. NHLs constitute a heterogeneous group of lymphoproliferative diseases, including entities with very different epidemiological and evolutive characteristics, as well as prognosis and treatments. Several classifications exist, but in practice, we individualize aggressive NHL including Diffuse Large B-Cell Lymphomas (DLBCL) which is the most common lymphoma, and indolent NHL including follicular lymphomas and mucosa-associated lymphoid tissue (MALT) lymphomas. The role of the radiotherapy in the management of NHLs varies according to the specific sub-type of lymphoma, but it has become increasingly limited over time. Overall it finds indications with curative intent only in situations of localized LMNH: either associated with chemotherapy as part of a combined modality therapy as for the treatment of localized DLBCL, or as exclusive treatment specially in the rare situations of localized follicular lymphomas. Moreover, lymphocytes being extremely radiosensitive cells, radiotherapy retains excellent indications with palliative intent for the management of symptomatic bulky tumor masses, and that whatever the sub-type of NHLs may be. It is important to remember that even today the "Involved Field" irradiation type remains the gold standard for the treatment of nodal NHLs, even if we witness at present the emergence of new types of irradiation, which aim to reduce the amount of irradiated tissues to try to limit the risks of delayed radio-induced complications. The purpose of this article is to clarify the specific aspects (epidemiological, radio-anatomical and prognostic characteristics) of each NHLs'sub-types (except primary central nervous system lymphomas), as well as the practical modalities of the irradiation (illustrated by a clinical case record) when an indication of radiotherapy is placed for their treatment.

摘要

在法国,非霍奇金淋巴瘤(NHL)每年约有10000例病例,是最常见的血液系统恶性肿瘤,占新发癌症病例的5%至10%。NHL是一组异质性的淋巴增殖性疾病,包括具有非常不同的流行病学和演变特征、预后及治疗方法的实体。目前存在多种分类,但在实际应用中,我们将侵袭性NHL个体化,包括最常见的淋巴瘤——弥漫性大B细胞淋巴瘤(DLBCL),以及惰性NHL,包括滤泡性淋巴瘤和黏膜相关淋巴组织(MALT)淋巴瘤。放射治疗在NHL治疗中的作用因淋巴瘤的具体亚型而异,但随着时间的推移,其作用越来越有限。总体而言,放射治疗仅在局限性LMNH的情况下有治愈性治疗指征:要么与化疗联合作为综合治疗模式的一部分,如治疗局限性DLBCL,要么在局限性滤泡性淋巴瘤的罕见情况下作为唯一治疗方法。此外,淋巴细胞是对辐射极其敏感的细胞,无论NHL的亚型如何,放射治疗对于有症状的巨大肿瘤块的姑息性治疗仍有很好的指征。重要的是要记住,即使在今天,“受累野”照射类型仍然是治疗淋巴结NHL的金标准,即使我们目前见证了新型照射方式的出现,其目的是减少受照射组织的量,以试图限制放射性迟发并发症的风险。本文的目的是阐明每种NHL亚型(原发性中枢神经系统淋巴瘤除外)的具体方面(流行病学、放射解剖学和预后特征),以及当有放射治疗指征时其照射的实际方式(通过临床病例记录说明)。

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