Hallahan D E, Farah R, Vokes E E, Bitran J D, Ultmann J E, Golomb H M, Weichselbaum R R
Pritzker School of Medicine, University of Chicago, IL.
Int J Radiat Oncol Biol Phys. 1989 Oct;17(4):767-71. doi: 10.1016/0360-3016(89)90064-3.
Radiation therapy was used to treat 36 patients with pathological Stage I and II diffuse histiocytic lymphoma at The University of Chicago Hospitals from 1970 to 1986. Twenty-two patients had pathological Stage I and 14 had pathological Stage II diffuse histiocytic lymphoma. The patients were treated with a median tumor dose of 50 Gy (range of 40-60 Gy). Therapy consisted of extended field radiation therapy in 27 patients (extended mantle or total nodal irradiation) and involved field irradiation in nine patients. The 10-year actuarial relapse-free survival for pathological Stage I and pathological Stage II patients was 91% and 35%, respectively (median follow-up of 7 years). None of the 22 pathological Stage I patients had bulky mediastinal or abdominal disease. Of the 22 pathological Stage I patients, one failed in an unirradiated contiguous lymph node and one relapsed with disseminated disease. Of the 14 pathological Stage II patients, two patients with bulky disease failed in field, one patient failed in a contiguous node, three patients failed within the abdomen, and three patients failed with disseminated disease. To better evaluate the efficacy of staging laparotomy, we analyzed the patterns of failure of 17 clinical Stage I and II diffuse histiocytic lymphoma patients. Four of these patients failed in field (three in sites of bulky disease), and five patients relapsed in the abdomen (three with disseminated disease). Salvage treatment with multiagent chemotherapy resulted in second complete responses in seven of ten patients; however, all but one have recurred and are dead of disease. Radiation therapy may be used as the sole treatment in patients with pathological Stage I diffuse histiocytic lymphoma without bulky disease. Patients with pathological Stage II diffuse histiocytic lymphoma and clinically staged patients have a higher incidence of dissemination and relapse within the abdomen. A benefit resulting from the administration of extended field irradiation was not revealed by this study.
1970年至1986年期间，芝加哥大学医院采用放射治疗对36例病理分期为I期和II期的弥漫性组织细胞淋巴瘤患者进行治疗。其中22例患者为病理I期，14例为病理II期弥漫性组织细胞淋巴瘤。患者接受的中位肿瘤剂量为50 Gy（范围40 - 60 Gy）。27例患者采用扩大野放射治疗（扩大的斗篷野或全淋巴结照射），9例患者采用受累野照射。病理I期和病理II期患者的10年精算无复发生存率分别为91%和35%（中位随访7年）。22例病理I期患者均无纵隔或腹部大包块病变。22例病理I期患者中，1例在未照射的相邻淋巴结出现复发，1例出现播散性疾病复发。14例病理II期患者中，2例有大包块病变的患者在野内复发，1例在相邻淋巴结复发，3例在腹部复发，3例出现播散性疾病复发。为了更好地评估分期剖腹术的疗效，我们分析了17例临床I期和II期弥漫性组织细胞淋巴瘤患者的复发模式。其中4例患者在野内复发（3例在大包块病变部位），5例患者在腹部复发（3例为播散性疾病）。十例患者中有七例经多药化疗挽救治疗后获得第二次完全缓解；然而，除1例患者外，其余均复发并死于疾病。对于无大包块病变的病理I期弥漫性组织细胞淋巴瘤患者，放射治疗可作为唯一的治疗方法。病理II期弥漫性组织细胞淋巴瘤患者和临床分期患者在腹部播散和复发的发生率较高。本研究未显示扩大野照射带来的益处。
