Richards M A, Gregory W M, Hall P A, Dhaliwal H S, Fernandez J, Stansfeld A G, Jones A E, Lister T A
ICRF Department of Medical Oncology, St. Bartholomew's Hospital, London, U.K.
Hematol Oncol. 1989 Jan-Feb;7(1):1-18. doi: 10.1002/hon.2900070102.
A retrospective study of 202 patients with clinical stage I and II non-Hodgkin's lymphoma managed at St. Bartholomew's Hospital between 1972 and 1985 was conducted. Patients were treated either with radiotherapy alone, radiotherapy and adjuvant chemotherapy, or chemotherapy (with or without adjuvant radiotherapy). At the onset of the study it was intended that all patients with localized NHL should be treated with involved field radiotherapy and adjuvant 'CVP'. As it became apparent that this was inadequate for some patients and too toxic for others a flexible approach was later adopted. Treatment selection depended on age, volume, distribution of disease and histological subtype. The actuarial 5 year overall survival for the whole group was 70 per cent. Death from lymphoma after 5 years was very rare. Increasing age and high grade histology were highly significant adverse prognostic factors by multivariate analysis. The results for patients with high grade and low grade histology were therefore analysed separately, as was the outcome for patients presenting with either gastrointestinal or skin lymphomas. During the latter part of the study period intensive chemotherapy was given as the initial treatment to patients with high grade histology and bulky, or stage II disease. Twenty out of 24 patients so treated achieved complete remission and only one has relapsed to date. These results are encouraging and probably explain the absence of a difference in prognosis between patients with stage I and IE disease and those with stage II and IIE disease observed over the whole period of the study. Remission was achieved in the overwhelming majority of patients with low grade histology for whom radiotherapy was selected as primary therapy. Duration of remission was better in patients who received adjuvant chemotherapy than in those treated with radiation alone, but no difference in overall survival was observed between these groups. Neither stage nor the presence of a follicular histological pattern correlated with prolonged survival in patients with low grade histology.
对1972年至1985年间在圣巴塞洛缪医院接受治疗的202例临床I期和II期非霍奇金淋巴瘤患者进行了一项回顾性研究。患者接受单独放疗、放疗联合辅助化疗或化疗（有或无辅助放疗）。在研究开始时，计划所有局限性非霍奇金淋巴瘤患者均接受受累野放疗和辅助“CVP”治疗。后来发现，这对一些患者来说不够充分，而对另一些患者来说毒性太大，因此采用了灵活的治疗方法。治疗方案的选择取决于年龄、疾病体积、分布和组织学亚型。整个组的5年总生存率为70%。5年后死于淋巴瘤的情况非常罕见。多因素分析显示，年龄增加和高级别组织学是非常显著的不良预后因素。因此，分别分析了高级别和低级别组织学患者的结果，以及胃肠道或皮肤淋巴瘤患者的结果。在研究后期，对高级别组织学、肿块较大或II期疾病的患者，初始治疗采用强化化疗。接受这种治疗的24例患者中有20例实现了完全缓解，迄今为止只有1例复发。这些结果令人鼓舞，可能解释了在整个研究期间观察到的I期和IE期疾病患者与II期和IIE期疾病患者预后无差异的原因。绝大多数选择放疗作为主要治疗方法的低级别组织学患者实现了缓解。接受辅助化疗的患者缓解期比单纯接受放疗的患者更好，但两组的总生存率没有差异。在低级别组织学患者中，分期和滤泡性组织学模式的存在均与生存期延长无关。
