Yu K H, Yu S C, Teo P M, Chan A T, Yeo W, Chow J
Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong.
Head Neck. 1997 Jul;19(4):251-9. doi: 10.1002/(sici)1097-0347(199707)19:4<251::aid-hed2>3.0.co;2-#.
Primary nasal lymphoma is a rare disease. Although most patients are initially seen in early Ann Arbor stages, their prognosis is poor. The prognostic significance of local tumor bulk has not been well studied.
Twenty-one patients with nasal lymphoma treated between 1985 and 1992 were retrospectively studied. Sixteen patients (76%) below the age of 75 years received combined radiotherapy and chemotherapy. One young patient with early disease and 4 elderly patients had radiotherapy alone. Twelve cases (57%) were diagnosed as pleomorphic T-cell lymphoma based on typical histologic features alone. Immunophenotyping was performed in 10 cases; 8 were T cell and 2 were B cell. Seventeen patients (81%) had Ann Arbor clinical stage IE disease, and 4 had stage IIE disease. The local tumor extent was assessed by endoscopy in all patients and by computerized tomography (CT) in 14 patients. Eleven local tumors (52%) extended to the posterior ethmoids, sphenoid sinus, orbit, or beyond. Using a T-stage system, the prognostic significance of local tumor bulk was evaluated for stage IE patients.
At a median follow-up time of 16.8 months, the lymphoma recurred in 13 patients; 10 patients had systemic relapse and 10 patients, local relapse. The 5-year actuarial overall survival rate was 24%. Complete response to chemotherapy was achieved in 5 of 16 patients (31%). Four of the 6 patients who remained alive and disease-free were chemotherapy complete responders. Among stage IE patients, those with early and those with advanced local disease did not have significantly different survival.
In view of the high systemic and local relapse rates, more-effective chemotherapy is needed to improve the survival rates, and the role of combined chemotherapy and radiotherapy should be evaluated. Further studies are required to identify patients at high risk of relapse for clinical trials with investigational treatment.
原发性鼻腔淋巴瘤是一种罕见疾病。尽管大多数患者初诊时处于Ann Arbor早期阶段，但其预后较差。局部肿瘤体积的预后意义尚未得到充分研究。
回顾性研究了1985年至1992年间接受治疗的21例鼻腔淋巴瘤患者。16例（76%）年龄在75岁以下的患者接受了放疗和化疗联合治疗。1例年轻的早期疾病患者和4例老年患者仅接受了放疗。12例（57%）仅根据典型组织学特征被诊断为多形性T细胞淋巴瘤。对10例患者进行了免疫表型分析；8例为T细胞型，2例为B细胞型。17例（81%）患者为Ann Arbor临床IE期疾病，4例为IIE期疾病。所有患者均通过内镜评估局部肿瘤范围，14例患者通过计算机断层扫描（CT）评估。11例局部肿瘤（52%）扩展至筛窦后部、蝶窦、眼眶或更远处。使用T分期系统，评估了IE期患者局部肿瘤体积的预后意义。
中位随访时间为16.8个月时，13例患者淋巴瘤复发；10例患者出现全身复发，10例患者出现局部复发。5年精算总生存率为24%。16例患者中有5例（31%）对化疗完全缓解。6例存活且无疾病的患者中有4例是化疗完全缓解者。在IE期患者中，早期和局部疾病晚期患者的生存率无显著差异。
鉴于全身和局部复发率较高，需要更有效的化疗来提高生存率，应评估化疗和放疗联合治疗的作用。需要进一步研究以确定复发高危患者，以便进行试验性治疗的临床试验。
