Baar J, Burkes R L, Bell R, Blackstein M E, Fernandes B, Langer F
Division of Medical Oncology, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Cancer. 1994 Feb 15;73(4):1194-9. doi: 10.1002/1097-0142(19940215)73:4<1194::aid-cncr2820730412>3.0.co;2-r.
This study relates our experience in the diagnosis and treatment of a rare clinical entity, non-Hodgkin's primary lymphoma of bone.
Seventeen cases of patients with primary lymphoma of bone diagnosed and treated at a single institution between 1975 and 1992 are reviewed. Ten patients received combined-modality therapy, consisting of an anthracycline-containing combination chemotherapy (CT) regimen, followed by adjuvant radiotherapy (RT) to the primary site of disease. Five patients were treated with CT alone; one patient received RT alone; and one patient was treated with CT after emergency RT for spinal cord compression.
Thirteen patients presented with Stage I disease, two with Stage II; and two with Stage IV disease (multiple bony sites only). Thirteen patients had an intermediate-grade diffuse large cell lymphoma; two had an intermediate-grade mixed small and large cell lymphoma; and two had a high-grade lymphoma (one immunoblastic and one small non-cleaved cell lymphoma). The overall response rate was 94% (18% complete response, 58% partial response 1, and 18% partial response 2). Thirteen patients are alive and disease-free at a median of 29 months; 10 of these received CT+RT, and 3 received CT alone. Three patients have died; one of these received CT+RT and one CT alone, and one relapsed immediately after CT. One patient, who was initially treated with RT and then with CT+RT after relapse, was lost to follow-up 40 months from the start of treatment.
Because experience in the literature suggests a 50% distant relapse rate in primary lymphoma of bone treated with RT alone, our policy is to treat all patients with combined-modality therapy (CT+RT). However, only a Phase III randomized, controlled clinical trial will determine whether CT+RT is superior to either modality alone.
本研究阐述了我们在诊断和治疗一种罕见临床病症——骨原发性非霍奇金淋巴瘤方面的经验。
回顾了1975年至1992年间在同一机构诊断和治疗的17例骨原发性淋巴瘤患者。10例患者接受了综合治疗，包括含蒽环类药物的联合化疗（CT）方案，随后对疾病原发部位进行辅助放疗（RT）。5例患者仅接受CT治疗；1例患者仅接受RT治疗；1例患者在因脊髓压迫进行紧急RT后接受CT治疗。
13例患者为Ⅰ期疾病，2例为Ⅱ期；2例为Ⅳ期疾病（仅多个骨部位受累）。13例患者为中级别弥漫大B细胞淋巴瘤；2例为中级别混合小和大细胞淋巴瘤；2例为高级别淋巴瘤（1例免疫母细胞性和1例小无裂细胞淋巴瘤）。总缓解率为94%（18%完全缓解，58%部分缓解1，18%部分缓解2）。13例患者存活且无疾病，中位时间为29个月；其中10例接受了CT + RT，3例仅接受CT。3例患者死亡；其中1例接受CT + RT，1例仅接受CT，1例在CT后立即复发。1例患者最初接受RT治疗，复发后接受CT + RT，自治疗开始40个月后失访。
由于文献中的经验表明，仅接受RT治疗的骨原发性淋巴瘤远处复发率为50%，我们的策略是对所有患者采用综合治疗（CT + RT）。然而，只有一项Ⅲ期随机对照临床试验才能确定CT + RT是否优于单独使用任何一种治疗方式。
