Epelbaum R, Haim N, Ben-Shahar M, Ben-Arie Y, Feinsod M, Cohen Y
Cancer. 1986 Nov 1;58(9):2120-4. doi: 10.1002/1097-0142(19861101)58:9<2120::aid-cncr2820580926>3.0.co;2-a.
Cord compression was noted at presentation in 10 of 453 (2.2%) previously untreated non-Hodgkin's lymphoma patients seen at the Northern Israel Oncology Center between 1968 and 1983. A prodromal phase of local back pain occurred in eight patients, persisting up to 1 year, followed by a second phase of rapidly progressive signs of cord compression. Five of the ten patients presented with primary spinal epidural involvement (Stage IE), whereas the others had Stage IIE and IIIE (one patient each) and Stage IV, with bone and bone marrow involvement (three patients). All patients had unfavorable histologic diagnoses, mostly of the intermediate grade malignancy types according to the Working Formulation. The patients were treated by radiotherapy (two patients), chemotherapy (three patients), or both modalities (five patients). Seven of the ten patients achieved complete remission, but four of them have subsequently had relapses (two patients in bone, one in central nervous system, and one in mediastinum). The 5-year actuarial survival and 3-year relapse-free survival were 66% and 32%, respectively. Median survival has not been reached after a mean follow-up of 34 months. Non-Hodgkin's lymphoma with spinal epidural involvement at presentation is an aggressive disease. An intensive treatment combining irradiation with chemotherapy, and surgery as needed, is suggested in order to achieve good local response and long-term survival.
1968年至1983年期间，在以色列北部肿瘤中心就诊的453例未经治疗的非霍奇金淋巴瘤患者中，有10例（2.2%）在初诊时发现有脊髓受压情况。8例患者出现了局部背痛的前驱期，持续长达1年，随后进入脊髓受压快速进展体征的第二阶段。10例患者中有5例表现为原发性脊柱硬膜外受累（IE期），其余患者分别为IIE期和IIIE期（各1例）以及IV期，伴有骨骼和骨髓受累（3例）。所有患者的组织学诊断均不佳，根据工作分类法，大多为中度恶性类型。患者接受了放射治疗（2例）、化疗（3例）或两种方式联合治疗（5例）。10例患者中有7例实现了完全缓解，但其中4例随后复发（2例骨骼复发，1例中枢神经系统复发，1例纵隔复发）。5年实际生存率和3年无复发生存率分别为66%和32%。平均随访34个月后，尚未达到中位生存期。初诊时伴有脊柱硬膜外受累的非霍奇金淋巴瘤是一种侵袭性疾病。建议采用放疗与化疗联合，并根据需要进行手术的强化治疗，以实现良好的局部反应和长期生存。
