颈淋巴结非霍奇金淋巴瘤是否需照射韦氏环  

Is prophylactic irradiation of Waldeyer's ring necessary for primary non-Hodgkin's lymphoma in the neck?

作　　者：顾仲义[1] 陆进成[1] 查文武[1] 朱向帜[1] 

机构地区：[1]江苏省肿瘤医院放射治疗科,南京210009

出　　处：《中华放射肿瘤学杂志》2001年第4期217-219,共3页Chinese Journal of Radiation Oncology

摘　　要：目的　探讨颈淋巴结非霍奇金淋巴瘤 (NHL)是否需预防照射韦氏环 ?方法　对颈淋巴结淋巴瘤 ,分期检查中特别注意剔除韦氏环、纵隔和腋窝受累者。 10 6例临床局限于颈淋巴结的NHL中 ,单纯放射治疗 17例 ,放射 +化疗 89例。化疗方案为CHOP或COMP。预防照射韦氏环者常规用面颈联合野 ,不照射韦氏环者主要用颈切线野。侵犯一侧颈者 (Ⅰ期 ) 90例 ,侵犯两侧颈者 (Ⅱ期 ) 16例。侵犯上中颈且病理为中高度恶性的 80例列入分析组。结果　分析组做化疗并预防照射韦氏环者 5年生存率和 5年无瘤生存率 (DFS)分别为 5 8.4%、5 8.8% ;做化疗未预防照射者 5年生存率和DFS分别为 6 7.4%及 6 3.8% (P值均 >0 .0 5 )。全组预防和未预防照射韦氏环者韦氏环复发率分别为 0 %(0 43)和 1.6 % (1 6 3) ,分析组中预防和未预防照射韦氏环者韦氏环复发率分别为 0 % (0 34 )和 2 .2 %(1 46 )。结论　颈淋巴结NHL似可不预防照射韦氏环 ,特别在做化疗 +放射综合治疗时更可如此。治疗前须常规做韦氏环特别是鼻咽部活检及CT检查 ,以排除原发性韦氏环NHL。Objective To investigate and discuss the necessity of prophylactic irradiation of Waldeyer's ring (WR) for non Hodgkin's lymphoma (NHL) in the cervical lymph nodes.Methods Only patients with cervical NHL without involving WR,mediastinum or axillary nodes were the subject of this study. 106 patients were evaluated in our retrospective analysis. All patients underwent radiotherapy and 89 chemotherapy also. Patients who received WR prophylactic radiation (Group A) were treated by faciocervical field and patients without WR prophylactic irradiation (Group B) were irradiated by the cervical tangential field. Of all,80 patients with upper/middle neck and intermediate high grade lesions were analized as a core cohort.Results For patients of the core cohort, the 5 year survival rates were 58.4% in Group A and 58.8% in Group B (P>0.05). The 5 year disease free survival rates were 67.4% and 63.8% (P>0.05). For all patients, the WR relapse rates were 0%(0/43) in Group A and 1.6%(1/63) in Group B and for the core patients, these rates were 0%(0/34) and 2.2% (1/46),respectively.Conclusions WR prophylactic irradiation is not advisable in treatment of cervical primary NHL, especially when chemotherapy was combined. It is to protect the major salivary glands from radiation damage and improve the patient's quality of life. However, it is extremely important to routinely examine WR by CT scan,pharyngorhinoscopy and WR biopsy to rule out primary WR NHL.

关 键 词：非霍奇金淋巴瘤 放射治疗 综合治疗 韦氏环 颈部淋巴部 NHL 

分 类 号：R739.91[医药卫生—肿瘤] R733.1[医药卫生—临床医学]