原发于纵隔大B细胞恶性淋巴瘤36例临床分析  

Clinical analysis of primary large B cell lymphoma of the mediastinum: a report of 36 cases

作　　者：郭小毛[1] 王坚[1] 施学辉[1] 何少琴[1] 

机构地区：[1]上海医科大学附属肿瘤医院放射治疗科

出　　处：《中华放射肿瘤学杂志》1998年第4期210-213,共4页Chinese Journal of Radiation Oncology

摘　　要：目的探讨原发于纵隔大Ｂ细胞恶性淋巴瘤的临床特性和治疗方法。材料与方法１９８０年至１９９２年，收治３６例原发于纵隔大Ｂ细胞恶性淋巴瘤。所有病理材料经复核和免疫组化检测。接受局部野照射１５例，大面积不规则野照射２１例。照射剂量＞４５Ｇｙ２３例，≤４５Ｇｙ１３例。２９例合并化疗。结果随访６３～２１３月。５年生存率６１．１％；５年无瘤生存率５８．３％；１０年生存率５８．４％；１０年无瘤生存率５５．５％。获得完全缓解（ＣＲ）者生存率明显高于部分缓解（ＰＲ）和进展（ＰＤ），Ｐ＜０．００１。肿瘤侵犯邻近器官者，其预后明显差于未侵犯邻近器官者，无Ｂ症状者预后优于有Ｂ症状者，但统计学分析差异无显著性。经Ｃｏｘ模型多因素分析，性别、年龄、肿块大小３因素对预后均无明显的影响。Ｌｏｇ－ｒａｎｋ检验局部野照射与大面积野照射，放射总剂量＞４５Ｇｙ与总量≤４５Ｇｙ之间的疗效，差异均无显著性意义。放化疗结合组的疗效明显优于单纯放疗组，Ｐ＝０．００４２。结论原发于纵隔大Ｂ细胞恶性淋巴瘤有独特的临床和病理特点。治疗以化疗为主。结合局部放射治疗，总剂量以４５Ｇｙ左右为宜。治疗结束后残留的病人应考虑调整化疗方案和（或）局部追加剂量，争取最大限度的?Purpose To analyze the clinical and pathological features of primary large B cell lymphoma of the mediastinum.Materials and Methods A retrospective analysis of 36 patients from 1980 to 1992 was carried out. All histopathologic materials were reviewed. Patients received radiation dose of 25～64 Gy/17～40 f,4～8 weeks with the local (15 cases) or the extended fields (21 cases).29 cases were treated with radiotherapy combined with chemotherapy.Results Follow up time ranged form 63～213 months.5 year and 10 year overall survival were 61.1% and 58.4%,respectively. The 5 year and 10 year disease free survival rates were 58.3% and 55.5%. The survival for CR was better than PR and PD(P<0.01). Tumour invading adjacent organs , size of radiation field and radiation dose (<45Gy vs ≥45Gy) did not result in significant differences of treatment outcomes (Log rank P=0.0974,0.3483,0.8349). Combination of chemotherapy with radiotherapy significantly impoved treatment results while compared to radiotherapy alone (P=0.004). Conclusion The data indicate that radiation therapy combined with chemotherapy give better outcomes than radiotherapy alone.

关 键 词：纵隔肿瘤 放射疗法 淋巴肉瘤 

分 类 号：R734.505[医药卫生—肿瘤] R733.405[医药卫生—临床医学]