Vigliotti A, Kong J S, Fuller L M, Velasquez W S
Int J Radiat Oncol Biol Phys. 1986 Oct;12(10):1807-12. doi: 10.1016/0360-3016(86)90323-8.
This study was undertaken to ascertain the influence of both more precise staging and more intensive treatment on results in 38 patients with Stage IE and IIE lymphomas of the thyroid. These patients were admitted between 1947 and 1984. Using the modified Rappaport system, the disease was classified as diffuse large cell in 32 patients. The initial investigation included lymphangiography in 25 patients, five of which had a staging laparotomy. The assigned stages were IEA--11, IEB--1, and IIEA--26. Treatment consisted of definitive radiotherapy alone in 15; combination chemotherapy and radiotherapy in 14; and chemotherapy alone in 6 patients. The remaining three patients were treated with surgery alone. In general, combination chemotherapy consisted of cyclophosphamide, Adriamycin, vincristine, and prednisone, with or without bleomycin (CHOP +/- Bleo). The overall 5-year survival and disease-free survival were 72 and 64%, respectively. For patients treated with radiotherapy only, results depended on stage. For Stage IE, the survival and disease-free survival were 100 and 83%, respectively. The corresponding Stage IIE results were 88 and 75%. Within this group, results were better for a subset of patients where disease did not involve the mediastinum. Survival and disease-free survival for combined modality treatment were both 77% (10 of these 17 patients had Stage IIE disease). Survival and disease-free survival for combination chemotherapy were 53 and 30% (all had Stage IIE disease). In conclusion, radiotherapy alone is excellent treatment for disease limited to the thyroid with or without cervical adenopathy. Results for patients with mediastinal extensions was unsatisfactory and the addition of combination chemotherapy is indicated.
本研究旨在确定更精确的分期和更强化的治疗对38例甲状腺IE期和IIE期淋巴瘤患者治疗结果的影响。这些患者于1947年至1984年间入院。采用改良的Rappaport系统，32例患者的疾病被分类为弥漫大细胞型。初始检查包括25例患者的淋巴管造影，其中5例行分期剖腹探查术。分配的分期为IEA期11例、IEB期1例和IIEA期26例。15例患者仅接受根治性放疗；14例接受联合化疗和放疗；6例仅接受化疗。其余3例患者仅接受手术治疗。一般来说，联合化疗由环磷酰胺、阿霉素、长春新碱和泼尼松组成，可加或不加博来霉素（CHOP±博来霉素）。总体5年生存率和无病生存率分别为72%和64%。仅接受放疗的患者，结果取决于分期。对于IE期，生存率和无病生存率分别为100%和83%。相应的IIE期结果为88%和75%。在该组中，疾病未累及纵隔的部分患者结果更好。联合治疗方式的生存率和无病生存率均为77%（这17例患者中有10例为IIE期疾病）。联合化疗的生存率和无病生存率分别为53%和30%（均为IIE期疾病）。总之，对于局限于甲状腺伴或不伴颈部淋巴结病的疾病，单纯放疗是很好的治疗方法。纵隔有扩展的患者结果不理想，需要加用联合化疗。
