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目的评价化疗、放疗、放疗+化疗及自体外周血干细胞移植(APBSCT)联合全身放疗(TBI)四种治疗方法对原发鼻腔非霍奇金淋巴瘤的疗效,并对影响预后的因素进行分析。方法20年间收治的原发鼻腔非霍奇金淋巴瘤135例全部经病理证实,其中T细胞来源122例,B细胞来源12例,NK细胞来源1例。放疗主野为鼻前凸字野,辅单或双侧耳前野,累及口咽者先用面颈联合野。鼻腔靶区中位剂量56.0Gy(35.2～75.5Gy)。TBI组剂量为8Gy,有2例原发灶加量30Gy。辅助化疗在放疗前、中、后进行或单纯化疗,方案为COP、COPP、COMP、CHOP、COBDP。用Cox模型对影响预后的多因素进行分析。结果单化组、单放组、放加化组及APBSCT联合TBI组局部控制率分别为12%、69%、76%、83%(P=0.057),5年总生存率分别为9%、52%、63%、83%(P=0.032)。除Ann Arbor分期外,局部侵犯范围、治疗方法也是影响预后的主要因素,而病理类型、性别、年龄及全身症状等因素对预后影响不大。结论放化联合的生存率优于单纯放疗。在AnnArbor分期的基础上依照局部侵犯部位进一步分区,对评价预后有意义。对于原发鼻腔非霍奇金淋巴瘤的治疗有条件者可试用APB SCT联合TBI。
Objective To evaluate the curative effect of four kinds of therapies including chemotherapy, radiotherapy, radiotherapy and chemotherapy and autologous peripheral blood stem cell transplantation (APBSCT) combined with systemic radiation therapy (TBI) on primary nasal non-Hodgkin’s lymphoma and to analyze the factors influencing the prognosis. Methods Totally 135 cases of primary nasal non-Hodgkin’s lymphoma were confirmed by pathology in 20 years. Among them, 122 cases were T-cell, 12 cases were B-cell and 1 case was NK. The main field of radiotherapy for the nose before the Convex word field, auxiliary single or bilateral ear field, who first involving the face and neck joint involving the wild field. The median nasal target dose of 56.0Gy (35.2 ~ 75.5Gy). TBI group dose of 8Gy, 2 cases of primary lesions plus 30Gy. Adjuvant chemotherapy in the radiotherapy before, during, after or chemotherapy alone, the program for the COP, COPP, COMP, CHOP, COBDP. Cox model was used to analyze the prognostic factors. Results The local control rates were 12%, 69%, 76%, 83% (P = 0.057) in the group of chemotherapy alone, the group of radiotherapy alone, the group of radiotherapy plus APBSCT and the group of TBI respectively. The 5-year overall survival rates were 9% 52%, 63%, 83% (P = 0.032). In addition to Ann Arbor staging, the scope of local violations, treatment is also a major factor affecting the prognosis, and pathological type, gender, age and systemic symptoms and other factors have little effect on prognosis. Conclusion The survival rate of combined radiotherapy and radiotherapy is superior to radiotherapy alone. On the basis of AnnArbor staging, further subdivision according to the site of local invasion is meaningful to evaluate the prognosis. For the treatment of primary nasal non-Hodgkin’s lymphoma can try APB SCT combined with TBI.