Giridhar Prashanth, Mallick Supriya, Bhasker Suman, Pathy Sushmita, Mohanti Bidhu Kalyan, Biswas Ahitagni, Sharma Atul
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi E-mail :
Asian Pac J Cancer Prev. 2015;16(15):6267-72. doi: 10.7314/apjcp.2015.16.15.6267.
Extra nodal lymphoma (ENL) constitutes about 33 % of all non-Hodgkin's lymphoma. 18-28% develops in the head and neck region. A multimodality treatment with multi-agent chemotherapy (CT) and radiotherapy (RT) is considered optimum.
We retrieved the treatment charts of patients of HNENL treated in our institute from 2001-2012. The charts were reviewed and the demographic, treatment details and outcome of HNENL patients were retrieved using predesigned pro-forma.
We retrieved data of 75 consecutive patients HNENL. Median age was 47 years (Range: 8-76 years). Of the 75 patients 51 were male and 24 were female. 55 patients were evaluable. The patient and tumor characteristics are summarized in Table 1. All patients were staged comprehensively with contrast enhanced computed tomography of head, neck, thorax, abdomen, pelvis and bone marrow aspiration and biopsy 66 patients received a combination multi-agent CT with CHOP being the commonest regimen. 42 patients received 4 or lesser number of cycles of chemotherapy whereas 24 received more than 4 cycles chemotherapy. Post radiotherapy, 41 out of 42 patients had a complete response at 3 months. Only 21 patients had a complete response after chemotherapy. All patients received radiation (mostly involved field radiation) as a part of the treatment. The median radiation dose was 45 Gray (Range: 36 Gray-50 Gray). The radiation was planned by 2D fluoro simulation based technique in 37 cases and by 3 Dimensional conformal radiation therapy (3DCRT) in 36 cases. Two patients were planned by the intensity modulated radiation therapy (IMRT) technique. IMRT was planned for one thyroid and one nasal cavity primary. 5 patients experienced relapse after a median follow up of 19 months. The median survival was not reached. The estimated two and three year survival were 92.9% (95%CI-68.6-95.35) and 88% (95%CI-60.82-92.66) respectively. Univariate analysis revealed higher stage and poorer baseline performance status to be significantly associated with worse progression free survival. 5 patients progressed (relapse or primary disease progression) after treatment. Of the 5 patients, two patients were primary orbital NHL, two patients had NHL nasal cavity and one was NHL thyroid.
Combined modality treatment in HNENL confers excellent disease control with acceptable side effects.
结外淋巴瘤（ENL）约占所有非霍奇金淋巴瘤的33%。18% - 28%发生于头颈部区域。多药化疗（CT）和放疗（RT）的多模式治疗被认为是最佳治疗方案。
我们检索了2001年至2012年在我院接受治疗的头颈部结外淋巴瘤（HNENL）患者的治疗记录。回顾这些记录，并使用预先设计的表格获取HNENL患者的人口统计学、治疗细节和预后情况。
我们检索了75例连续的HNENL患者的数据。中位年龄为47岁（范围：8 - 76岁）。75例患者中，51例为男性，24例为女性。55例患者可进行评估。患者和肿瘤特征总结于表1。所有患者均通过头、颈、胸、腹、盆腔的增强计算机断层扫描以及骨髓穿刺和活检进行全面分期。66例患者接受了联合多药CT治疗，其中CHOP方案最为常用。42例患者接受了4个或更少周期的化疗，而24例患者接受了超过4个周期的化疗。放疗后，42例患者中有41例在3个月时达到完全缓解。化疗后只有21例患者达到完全缓解。所有患者均接受了放疗（大多为受累野放疗）作为治疗的一部分。中位放疗剂量为45格雷（范围：36格雷 - 50格雷）。37例患者的放疗计划采用基于二维荧光模拟的技术，36例患者采用三维适形放疗（3DCRT）。2例患者采用调强放疗（IMRT）技术进行计划。IMRT计划用于1例甲状腺原发和1例鼻腔原发。中位随访19个月后，5例患者出现复发。中位生存期未达到。估计的两年和三年生存率分别为92.9%（95%CI - 68.6 - 95.35）和88%（95%CI - 60.82 - 92.66）。单因素分析显示，较高分期和较差的基线身体状况与较差的无进展生存期显著相关。5例患者治疗后病情进展（复发或原发性疾病进展）。在这5例患者中，2例为原发性眼眶非霍奇金淋巴瘤，2例为鼻腔非霍奇金淋巴瘤，1例为甲状腺非霍奇金淋巴瘤。
HNENL的综合治疗可实现良好的疾病控制，且副作用可接受。
