Prestidge B R, Horning S J, Hoppe R T
Department of Therapeutic Radiology, Stanford University Medical Center, CA 94305.
Int J Radiat Oncol Biol Phys. 1988 Sep;15(3):633-9. doi: 10.1016/0360-3016(88)90305-7.
Between January 1978 and December 1986, 94 patients with Stage I-II large cell lymphoma were evaluated at Stanford University Medical Center and treated with a combination of chemotherapy (CTX) and irradiation (XRT). The predominant histology was diffuse large cell (78), followed by immunoblastic (7), follicular large cell (6), and diffuse mixed small and large cell lymphoma (3). Twenty-three patients had Stage I and 71 had Stage II disease. Fifty-one had extranodal involvement (13 IE, 38 IIE), and 11 had B symptoms (2 IB, 9 IIB). Lymphoma was supradiaphragmatic in 58 patients, infradiaphragmatic in 21, and only in extranodal sites in 15. Patients received either involved (81) or extended (13) field XRT with a median dose of 40 Gy and combination CTX with 2 to 9 cycles (median 6) of either CHOP (68), M-BACOD (8), C-MOPP (8), MACOP-B (4), or other (6). Seventy-two patients remain with no evidence of disease, 21 are dead with disease, and one suffered an intercurrent death. Among the 19 patients who relapsed, there were six failures within the XRT field only, two within and outside the XRT field, and 11 outside of the XRT fields only. Actuarial survival and freedom from relapse (FFR) for the entire population were 74% and 72% at 5-years, respectively (33 month median follow-up). Stage I patients achieved 81% survival and 78% FFR, and Stage II patients had 72% survival and 70% FFR. In univariate and multivariate analyses, a favorable outcome was associated with the CTX-XRT-CTX sequence of therapy (p = 0.001), low LDH (p = 0.01), and small tumor bulk (p = 0.04). There were no relapses or deaths among the 21 patients receiving the "sandwich" sequence (CTX-XRT-CTX) of therapy. This series may serve as a comparison with single modality treatment programs for localized large cell lymphoma using either XRT or CTX alone.
1978年1月至1986年12月期间，斯坦福大学医学中心对94例I-II期大细胞淋巴瘤患者进行了评估，并采用化疗（CTX）和放疗（XRT）联合治疗。主要组织学类型为弥漫大细胞型（78例），其次为免疫母细胞型（7例）、滤泡大细胞型（6例）和弥漫性混合小细胞和大细胞淋巴瘤（3例）。23例患者为I期，71例为II期。51例有结外受累（13例IE，38例IIE），11例有B症状（2例IB，9例IIB）。淋巴瘤位于膈肌上的有58例，膈肌下的有21例，仅累及结外部位的有15例。患者接受受累野（81例）或扩大野（13例）放疗，中位剂量为40 Gy，并联合CTX化疗，采用CHOP方案（68例）、M-BACOD方案（8例）、C-MOPP方案（8例）、MACOP-B方案（4例）或其他方案（6例），共进行2至9个周期（中位6个周期）。72例患者无疾病证据存活，21例死于疾病，1例死于并发疾病。在19例复发患者中，仅在放疗野内复发6例，放疗野内外均复发2例，仅在放疗野外复发11例。整组患者的5年总生存率和无复发生存率（FFR）分别为74%和72%（中位随访33个月）。I期患者的生存率为81%，FFR为78%；II期患者的生存率为72%，FFR为70%。单因素和多因素分析显示，良好的预后与CTX-XRT-CTX治疗顺序（p = 0.001）、低乳酸脱氢酶（LDH）水平（p = 0.01）和小肿瘤体积（p = 0.04）相关。接受“三明治”治疗顺序（CTX-XRT-CTX）的21例患者中无复发或死亡。本系列研究可作为与单独使用XRT或CTX的局限性大细胞淋巴瘤单一治疗方案的比较。
