Blair T J, Evans R G, Buskirk S J, Banks P M, Earle J D
Int J Radiat Oncol Biol Phys. 1985 Feb;11(2):365-70. doi: 10.1016/0360-3016(85)90159-2.
The purpose of this study was to evaluate the radiotherapeutic management of 38 patients, with malignant lymphoma of the thyroid, seen at the Mayo Clinic between 1965 and 1979. There were 8 males and 30 females with ages ranging from 34 to 90 years (mean age of 65 years). A tissue diagnosis was made in all patients and tissue was available for reclassification under the "Working Formulation" in 31 of the 38 patients. Twenty-six patients had intermediate grade histology, four low grade and one indeterminate. Twenty patients were clinical Stage IE, 14 patients Stage IIE, one patient Stage IIIE, one patient Stage IV and two patients were unstaged. All patients were treated with approximately 4000 rad megavoltage irradiation (range 2400-6000 rad) to the neck only (10 patients) or neck and mediastinum (28 patients). Twenty patients received subdiaphragmatic radiotherapy and four patients received adjuvant chemotherapy. Median follow-up was 56 months with minimum follow-up of 30 months. Overall disease-free survival at five years was 59%. Of 14 patients who experienced a recurrence, 10 (71%) failed in two or more sites. The most common site of failure was in para-aortic lymph nodes. One year survival following recurrence was 29%; however, four of six patients receiving salvage therapy survived at least two years. Patients receiving radiation treatment to the neck and mediastinum and those with no gross residual disease at the initiation of radiotherapy were less likely to develop a recurrence. Patients receiving a planned break during the course of therapy did not have reduced overall disease-free survival. However, 4 of 20 patients (20%) who received split course therapy failed within the radiation fields compared to 2 of 18 patients (11%) who had no treatment break. Only 1 of 4 patients (25%) receiving adjuvant chemotherapy survived one year. Side effects of radiotherapy were minimal. We believe the radiotherapeutic management of clinical Stage IE and IIE primary thyroid lymphoma should include treatment of the neck, axillae and mediastinum to a dose of approximately 4000 rad using a continuous course technique. Additionally, gross total removal of the disease surgically may be beneficial.
本研究的目的是评估1965年至1979年间在梅奥诊所就诊的38例甲状腺恶性淋巴瘤患者的放射治疗管理情况。其中男性8例，女性30例，年龄在34岁至90岁之间（平均年龄65岁）。所有患者均进行了组织诊断，38例患者中有31例的组织可根据“工作分类法”重新分类。26例患者组织学分级为中级，4例为低级，1例为不确定级。20例患者为临床IE期，14例为IIE期，1例为IIIE期，1例为IV期，2例未分期。所有患者均仅对颈部（10例患者）或颈部及纵隔（28例患者）进行了约4000拉德的兆伏级照射（范围为2400 - 6000拉德）。20例患者接受了膈下放疗，4例患者接受了辅助化疗。中位随访时间为56个月，最短随访时间为30个月。五年总体无病生存率为59%。在14例复发的患者中，10例（71%）在两个或更多部位出现失败。最常见的失败部位是主动脉旁淋巴结。复发后一年生存率为29%；然而，接受挽救治疗的6例患者中有4例存活至少两年。接受颈部及纵隔放疗的患者以及放疗开始时无明显残留病灶的患者复发的可能性较小。在治疗过程中接受计划中断的患者总体无病生存率没有降低。然而，接受分割疗程治疗的20例患者中有4例（20%）在放射野内出现失败，而未中断治疗的18例患者中有2例（11%）出现失败。接受辅助化疗的4例患者中只有1例（25%）存活一年。放疗的副作用最小。我们认为，临床IE期和IIE期原发性甲状腺淋巴瘤的放射治疗管理应包括使用连续疗程技术对颈部、腋窝和纵隔进行约4000拉德的剂量照射。此外，手术彻底切除病灶可能有益。
