Département de Radio-Oncologie, Hôpital Maisonneuve-Rosemont, Montréal, Canada.
Leuk Lymphoma. 2013 Feb;54(2):261-7. doi: 10.3109/10428194.2012.711828. Epub 2012 Sep 10.
Mantle-cell lymphoma (MCL) is a rare cancer, with the majority of patients (pts) presenting in stage III-IV and the outcomes are poor. To determine the curability of localized MCL, we examine stage I-II pts at our institution between 1990-2007. 26 pts with stage I (38%) and stage II (62%) were referred. Sites involved were head and neck in 73%. Five had a blastoid variant. Five patients were treated with palliative intent. Analysis was focused on pts treated with a curative intent (21 pts): 17 CT+RT, 2 RT, 2 CT followed by ASCT. 13 patients received CHOP, 5-RCHOP, 1-CVP; most received 6 cycles. The RT median dose was 35Gy and IFRT for the majority. For 21 pts treated with a curative intent, median follow up was 5.8 years. The overall response rate was 95%. Among the 19 CR/CRu pts, 9 relapsed for a 5-year relapse rate of 46%. Relapses were mainly observed at distant sites, 3 were in GI tract, 1 had both local and distant relapse. Median PFS and OS were 3.2 and 6.4 years, respectively. 5-year OS was 62%. In univariate analysis, blastoid variant and stage II were prognostic factors for PFS. Multivariate analysis could not be performed due to the small sample size. With a treatment approach using combined CT+RT for stage I-II MCL, local control was achieved in 94%. Systemic relapse remains a significant problem, especially for stage II and blastoid variant. Radiotherapy should remain part of curative treatment plan in stage I-II MCL.
套细胞淋巴瘤（MCL）是一种罕见的癌症，大多数患者（pts）在 III-IV 期就诊，预后较差。为了确定局限性 MCL 的可治愈性，我们检查了 1990 年至 2007 年间我们机构的 I 期和 II 期患者。有 26 名 I 期（38%）和 II 期（62%）患者被转诊。受累部位为头颈部 73%。有 5 例患者存在 blastoid 变体。有 5 例患者以姑息为目的接受治疗。分析重点是采用根治性治疗的患者（21 例）：17 例 CT+RT、2 例 RT、2 例 CT 后 ASCT。13 例患者接受 CHOP 治疗，5 例接受 RCHOP 治疗，1 例接受 CVP 治疗；大多数患者接受了 6 个周期的治疗。RT 中位剂量为 35Gy，大部分采用 IFRT。对于 21 例采用根治性治疗的患者，中位随访时间为 5.8 年。总缓解率为 95%。在 19 例获得完全缓解/部分缓解的患者中，有 9 例复发，5 年复发率为 46%。复发主要发生在远处部位，3 例发生在胃肠道，1 例发生局部和远处复发。中位 PFS 和 OS 分别为 3.2 年和 6.4 年。5 年 OS 率为 62%。在单因素分析中，blastoid 变体和 II 期是 PFS 的预后因素。由于样本量小，无法进行多因素分析。采用 CT+RT 联合治疗 I 期和 II 期 MCL，局部控制率达到 94%。系统复发仍然是一个严重的问题，特别是对于 II 期和 blastoid 变体患者。放疗应仍然是 I 期和 II 期 MCL 根治性治疗计划的一部分。
