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Objective:To analyze the efficacy and prognostic factors of induced chemotherapy combined with radiotherapy in the treatment of early stage extranodal natural-killer/T cell lymphoma (ENKTCL).Methods:Two hundred and eighty-seven early stage NKTCL patients were treated in Affiliated Cancer Hospital of Guizhou Medical University from October 2003 to October 2021. All patients were aD ministrated with short courses of induced chemotherapy combined with radiotherapy. Clinical prognostic factors of early stage NKTCL were analyzed. The overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan- Meier method, log-rank test was conducted for univariate analysis and Cox models were performed for multivariate analysis. Results:The 5-year OS and PFS were 72.8% and 68.9% in all patients. According to Nomogram risk index (NRI) prognostic model, 286 patients were divided into the low risk (NRI=0), intermediate low risk (NRI=1), intermediate high risk (NRI=2), high risk (NRI=3) and very high risk (NRI≥4) groups. In these 5 groups, the 5-year OS were 95.6%, 76.3%, 69.5%, 61.0% and 23.3%(all P<0.001), and the 5-year PFS were 93, 2%, 69.8%, 64.6%, 60.2% and 23.3%(all P<0.001), respectively. In the radiotherapy with a dose of ≥50 Gy and<50 Gy groups, the 5-year OS were 73.8% and 65.9%( P=0.123) and the 5-year PFS were 72.8% and 45.3%( P=0.001). According to the response to induced chemotherapy of complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD), the 5-year OS were 85.4%, 74.0%, 61.8% and 28.5%(all P<0.001), and the 5-year PFS were 83.7%, 66.8%, 65.7% and 27.4%(all P<0.001), respectively. Univariate analyses showed that stage Ⅱ, ECOG≥2, primary tumor invasion, radiotherapy dose<50 Gy and short-term efficacy of induced chemotherapy were poor prognostic factors for the 5-year OS and PFS (all P<0.05). Multivariate analyses demonstrated that primary tumor invasion, ECOG≥2 and stage Ⅱ were poor prognostic factors for OS (all P<0.05), and primary tumor invasion and ECOG≥2 were poor prognostic factors for PFS (all P<0.05). Conclusions:Early stage NKTCL patients can obtain high efficacy after induced chemotherapy combined with radiotherapy. Complete response to induced chemotherapy is associated with favorable prognosis.
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Objective:To analyze the efficacy and prognostic factors of radiotherapy combined with asparaginase/peaspartase-based chemotherapy regimen in the treatment of early stage extranodal natural-killer/T cell lymphoma of the upper aerodigestive tract (UADT ENKTCL).Methods:267 early stage UADT ENKTCL patients were treated in Guizhou Cancer Hospital from October 2003 to February 2020. Among them, 229 patients received radiotherapy or radiotherapy combined with menpartaminase/permenidase-based chemotherapy regimen and 38 patients were treated with radiotherapy or chemotherapy alone. The overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan- Meier method, log-rank test was conducted for univariate analysis and Cox regression model was performed for multivariate analysis. Results:The 5-year OS and PFS were 67.2% and 61.5% in all patients. The 5-year OS and PFS in patients treated with radiotherapy combined with chemotherapy, radiotherapy alone and chemotherapy alone were 71.7%, 35% and 49%(all P<0.001), and 66.4%, 35% and 28%(all P<0.001), respectively. According to the NRI risk stratification, 246 patients treated with radiotherapy and chemotherapy were divided into the favourable and the unfavourable prognosis groups. The 5-year OS was 93.3% and 64.3%( P<0.001) and the 5-year PFS was 91.1% and 56.7%( P<0.001) in two groups. For patients receiving radiotherapy with a dose ≥50 Gy and<50 Gy, the 5-year OS was 72.4% and 55.7%( P<0.001), and the 5-year PFS was 68.3%, and 36.5%( P<0.001). In the unfavourable prognosis group, the 5-year OS of patients receiving ≥ 4 and<4 cycles of chemotherapy was 65.5% and 59.2%( P=0.049), and the 5-year PFS was 60.7% and 50.6%( P=0.018). Univariate analysis showed that stage Ⅱ, ECOG≥2, primary tumor invasion, radiotherapy alone, NRI≥1(Nomogram-revised risk index), EBV-DNA≥2 750 copies/ml, radiotherapy dose < 50 Gy, and<4 cycles of chemotherapy were associated with unfavorable 5-year OS and PFS (all P<0.05), and CHOP-like regimen was the risk factor of unfavorable 5-year PFS ( P<0.05). Multivariate analysis demonstrated that primary tumor invasion, ECOG≥2, and radiotherapy dose <50 Gy were associated with unfavorable OS and PFS (all P<0.05), and stage Ⅱ was the risk factor of unfavorable 5-year OS ( P<0.05). Conclusions:The prognosis of early stage low-risk UADT ENKTCL of is favourable. Sufficient dose of extended involved-field radiotherapy is an important curative modality in early stage UADT ENKTCL. Compared with radiotherapy alone, radiotherapy combined with chemotherapy can significantly improve the prognosis of early stage UADT ENKTCL patients in the unfavourable prognosis group. Full-course chemotherapy can significantly prolong the long-term survival in the unfavorable prognosis group. The chemotherapy containing asparaginase can significantly enhance the prognosis of patients with early stage UADT ENKTCL.
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Extranodal natural killer/T-cell lymphoma (ENKTCL) is the subtype of non-Hodgkin lymphoma with high heterogeneity and invasiveness. Though most ENKTCL patients are present as early-stage at diagnosis, clinical prognosis significantly differs due to the limitations of clinical staging. Radiotherapy (RT) and chemotherapy (CT) are the first-line treatments for early ENKTCL patients. However, there is no consensus on the combined modalities of RT and CT, and their optimal strategy. With the continuous renewal of clinical staging and prognostic models, early-stage ENKTCL patients tend to accept risk-adapted treatment with proper stratification. In this review, the latest research progresses on clinical staging, prognostic models and treatment were retrospectively analyzed, aiming to provide references for clinical decision-making.
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Objective To explore the role of radiotherapy in the treatment of primary central nervous system lymphoma. Methods Clinical data of 60 patients diagnosed with primary central nervous system lymphoma from September 2010 to December 2017 were retrospectively analyzed. Among them, 50 cases were diagnosed by histopathological examination after stereotactic biopsy or tumor resection and 10 patients were diagnosed by gadolinium enhanced magnetic resonance imaging ( MRI) . Fifty-two patients underwent chemotherapy, and 45 of them received methotrexate-based chemotherapy, 25 received rituximab-based regimen. Twenty-seven patients were given with planned whole brain radiotherapy, while 33 patients were not. Salvage radiotherapy was delivered in 9 patients after treatment failure. Results The median follow-up time was 28 months ( 5-70 months) . The median overall survival time and median progression-free survival time of the whole patients was 22 months ( 5-65 months) and 13 months ( 5-55 months) , respectively. The 4-year overall survival rate and progression-free survival rate were 61% and 33%, respectively. The 4-year overall survival rates between patients with and without planned whole brain radiotherapy were 68% and 54% ( P=0.083) . The 4-year progression-free survival rates between patients with and without planned whole brain radiotherapy were 47% and 20% ( P=0.014) , respectively. Patients with and without salvage whole brain radiotherapy had a 4-year overall survival of 49% and 68%, respectively ( P=0.398) . Among patients who received whole brain radiotherapy, patients with a lower dose of ≤36 Gy had a similar overall survival compared with those with a higher dose of>36 Gy ( 80% vs. 45%, P=0.136) . Conclusions Radiotherapy is part of the comprehensive treatment of primary central nervous system lymphoma. Planned radiotherapy may bring clinical benefits to patients during the comprehensive therapy. However, the irradiation dose to the whole brain should not be too high because of neurotoxicity.
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Primary central nervous system lymphoma (PCNSL) is a type of extranodal non-Hodgkin lymphoma.Whole brain radiation therapy (WBRT) combined with high-dose methotrexate is the standard treatment.Although PCNSL patients are sensitive to radiation therapy,the duration of response is relatively short and it is likely to provoke delayed neurotoxicity,especially in the elderly patients.Reduced-dose WBRT and autologous stem cell transplantation (ASCT) can lower the risk of neutotoxicity,whereas the clinical efficacy remains to be validated.For the elderly patients with PCNSL,application of WBRT in the first-line treatment should be cautiously considered.
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Objective To evaluate the dose response and prognosis of patients with stage ⅠE primary ocular adnexal mucosa associated lymphoid tissue lymphoma (POAml) treated with radiotherapy.Methods Clinical date of 93 patients (117 eyes) with stage ⅠE POAml treated from November 2003 to July 2015 were retrospectively analyzed.The dose response was evaluated by observing the ocular changes in exophthalmos.The survival rate was calculated by using the Kaplan-Meier survival analysis.The log-rank test and univariate analysis were used for prognostic analysis.Results For patients treated with a dose of ≥ 27 Gy,the response rate of exophthalmos was 69.0％(29/42).The median response dose was 7.2 Gy (5.4-19.8 Gy).For all patients,the local control rate was 100％.The 5-and 10-year overall survival (OS) rates were 92％ and 82％.The 5-and 10-year cause-specific survival (CSS) rates were equally 98％.The 5-and 10-year progression-free survival (PFS) rate were 90％ and 88％.The univariate prognostic analysis demonstrated that the International Prognostic Index (IPI) score and age were the prognostic factors of PFS rate (both P=0.04).Conclusions POAml is sensitive to radiation therapy.Radiotherapy alone can yield excellent local control and long-term survival in POAml patients.A prescription dosage of 18 Gy dose can obtain favorable clinical efficacy.
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Objective To retrospectively analyze the prognostic factors for locoregionally recurrent early?stage extranodal nasal?type natural killer/T?cell lymphoma ( NKTCL) . Methods A total of 56 patients with early?stage extranodal nasal?type NKTCL, who had locoregional recurrence after initial treatment and then received salvage treatment from 1995 to 2014, were enrolled as subjects. The effects of salvage treatment on the overall survival ( OS) rate were analyzed after initial treatment and recurrence. Univariate and multivariate prognostic analyses were performed on the OS rate after recurrence. Results The median follow?up time was 35. 9 months after initial treatment and 14. 8 months after recurrence. The 3?year OS rate was 73% after initial treatment and 58% after recurrence. Compared with chemotherapy alone, radiotherapy?containing salvage treatment significantly improved the OS rates after initial treatment and recurrence ( P=0. 040, 0. 009 ) , and re?irradiation also significantly improved the OS rates after initial treatment and recurrence (P=0. 018, 0. 019). Most (84%) of the acute and late adverse reactions after re?irradiation were grade 1?2 ones. The univariate and multivariate analyses showed that the Karnofsky Performance Status score, radiotherapy in initial treatment, and radiotherapy in salvage treatment were influencing factors for the OS rate after recurrence. Conclusions Radiotherapy achieves improved survival and tolerable toxicities, making it indispensable in the treatment of locoregionally recurrent extranodal nasal?type NKTCL.
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Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL).Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL),consolidation after systemic therapy,salvage treatment,or palliation.The wide range of presentations of ENL,involving any organ in the body and the spectrum of histological sub-types,poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies.This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians.Thus far there is a lack of guidelines for the use of RT in the management of ENL.This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL,and to address the technical challenges of simulation,volume definition and treatment planning for the most frequently involved organs.Specifically,detailed recommendations for RT volumes are provided.We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL.We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU),as has been widely adopted by the field of radiation oncology for solid tumors.Organ-specific recommendations take into account histological subtype,anatomy,the treatment intent,and other treatment modalities that may be have been used before RT.
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Objective This study aimed to evaluate the prognostic value of regional lymph node spread in patients with stage Ⅱ nasal-type NK/T-cell lymphoma of the upper aerodigestive tract (UADT-NKTCL).Methods From 1987 to 2013,a total of 97 patients with newly-diagnosed stage Ⅱ UADT-NKTCL were retrospectively reviewed.Primary tumors were located in the nasal cavity (n=52) or extranasal UADT sites (n=45).The majority of patients were treated with primary radiotherapy.Sixty-five patients were treated with combined modality therapy (CMT),and 32 patients were treated with radiotherapy alone (n=27) or chemotherapy alone (n=5).The Kaplan-Meier method was used to calculate the survival rate,and the log-rank test was used for survival difference analysis and monovariate prognostic analysis.The Cox regression model was used to multivariate prognostic analysis.Results The 5-year overall survival (OS) and progression-free survival (PFS) rates for all stage Ⅱ patients were 57% and 49%,respectively.The presence of a lower neck lymph node (defined as extension below the caudal border of the cricoid cartilage) was significantly associated with poor outcomes on univariate analysis and maintained significance on multivariate analysis.The median survival for patients with lower neck lymph node was 19.3 months and the 2-,5-years OS rates were 28% and 11%(P=0.000).For stage Ⅱ patients,CMT significantly improved survival.The 5-year OS and PFS rates were 64% and 52% for CMT,compared with 40.4%(P=0.006) and 42% for single modality therapy (P=0.088).Conclusion The level of regional lymph node is a powerful prognostic factor for stage Ⅱ UADT-NKTCL.The involvement of low neck lymph node is significantly associated with poorer survival outcomes.
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Primary mediastinal large B-cell lymphoma (PMBCL) is morphologically similar to diffuse large B-cell lymphoma (DLBCL) and nodular sclerosis Hodgkin lymphoma.For most PMBCL patients, chemotherapy plus consolidation radiotherapy showed that the latter could improve PMBCL responsiveness and progression-free survival (PFS), and its combined use with chemotherapy demonstrated higher therapeutic efficacy.Recent clinical studies suggested that rituximab and anthracycline chemotherapy regimens could increase PMBCL treatment efficacy, reduce early treatment failure, enhance PFS and overall survival, and improve prognosis.Although rituximab combined with some high-intensity chemotherapy without radiotherapy have achieved good results, many studies still support the use of post-immunochemotherapy consolidation mediastinal radiotherapy.Based on the results of a few studies with a small sample size, patients who were assessed as complete metabolic remission by PET following high-intensity immunochemotherapy may omit consolidation radiotherapy.However, these results will need to be further confirmed by large-sample multicenter clinical trials.Consolidation radiotherapy is recommended for patients with poor prognostic factors or PET score>3.
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Objective To investigate prognostic factors in patients with primary central nervous system diffuse large B-cell lymphoma (PCNS-DLCBL).Methods The clinical data of 71 patients with PCNS-DLCBL confirmed by pathology and clinical tests, who were admitted to our hospital from 1991 to 2015, were retrospectively analyzed.All patients received chemotherapy, mainly with high-dose methotrexate (HD-MTX, 66/71), and 59 patients received radiotherapy, mainly with whole brain radiotherapy (WBRT)±local boost.The Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for survival comparison and univariate prognostic analysis, and the Cox model was used for multivariate prognostic analysis.Results Fifty-eight patients achieved a complete response (CR), ten achieved a partial response (PR), and three had progressive disease (PD).The 5-year overall survival (OS) rate was 43%, and the 5-year progression-free survival (PFS) rate was 34%.The univariate analysis showed that the factors associated with OS included the following:age of onset, Karnofsky Performance Scale (KPS) score, single or multiple lesions, whether to receive radiotherapy, evaluation results after radiotherapy and chemotherapy, and the presence or absence of recurrence (P=0.000-0.047);the multivariate analysis showed that the three factors that affected OS were age of onset, KPS score, and the presence or absence of recurrence (P=0.000-0.022).The univariate analysis revealed that chemotherapy regimen, whether to receive radiotherapy, total radiotherapy dose, WBRT dose, evaluation results after radiotherapy and chemotherapy, and the presence or absence of recurrence were the factors associated with PFS (P=0.000-0.028);the multivariate analysis revealed that KPS score and the presence or absence of recurrence were associated with PFS (P=0.000-0.011).Conclusions Among patients with PCNS-DLCBL, younger age, higher KPS score, and no recurrence are associated with better OS, and single lesion, radiotherapy, and better evaluation results after radiotherapy and chemotherapy may be associated with better OS;higher KPS score, better evaluation results after radiotherapy and chemotherapy, and no recurrence are the factors associated with better PFS, and HD-MTX chemotherapy, radiotherapy, higher total radiotherapy dose, and higher WBRT dose may be associated with better PFS.Whether to receive radiotherapy after achieving a CR with chemotherapy and the target area and dose of radiotherapy need to be further studied.
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Objective To evaluate the efficacy of extended-field intensity-modulated radiotherapy (IMRT) in the treatment of patients with early-stage NK/T cell lymphoma (NKTCL),and to examine the clinical characteristics and the effect of treatment factors on the prognosis of these patients.Methods The clinical data of 165 patients with early-stage NKTCL who underwent extended-field IMRT with (n=158,95.8%) or without chemotherapy (n=7,4.2%) were reviewed.Of these 165 patients,140(84.8%) received a radiation dose of ≥50 Gy to the primary lesion,and 25 patients (15.2%) received a radiation dose of<50 Gy.Most patients (n=147,89.1%) were treated with L-asparaginase-based chemotherapy regimens,whereas only 11 patients (6.7%) were treated with doxorubicin-based CHOP/CHOP-like regimens.In addition,109 patients (66.1%) received ≥4 cycles of chemotherapy.Locoregional control (LRC),overall survival (OS),and progression-free survival (PFS) rates were calculated using the Kaplan-Meier method,and the log-rank test was used for survival comparison and univariate prognostic analysis.A multivariate prognostic analysis was performed using the Cox model.Results The 5-year sample size 55.The 5-year OS,PFS,and LRC rates of all patients were 74.2%,72.5%,84.4%,respectively.The patients who received a dose of ≥50 Gy had a significantly higher 5-year LRC rate than those with<50 Gy (91.8% vs.39.7%,P=0.000).The 5-year OS was significantly higher in the low-risk early-stage group than in the high-risk early-stage group (P=0.002).For the high-risk early-stage NKTCL group,patients who received ≥4 cycles of chemotherapy had significantly higher 5-year OS and PFS than those who received<4 cycles of chemotherapy (5-year OS:71.3% vs.59.5%,P=0.032;5-year PFS:70.4% vs.54.4%,P=0.009).In addition,multivariate analysis showed that ECOG≥2,primary tumor invasion (PTI),and Ann Arbor stage Ⅱ were associated with poor OS (P=0.006,0.002,0.014),and ECOG≥2 and PTI were associated with reduced LRC (P=0.004,0.016).Furthermore,ECOG≥2,PTI,Ann Arbor stage Ⅱ,and extranasal primary site were associated with lower PFS (P=0.045,0.003,0.030,0.032).Conclusions Extended-field IMRT at a dose of ≥50 Gy can lead to favorable LRC,OS,and PFS in patients with early-stage NKTCL.However,it is less effective against distant early-stage NKTCL in patients with poor prognosis.Nevertheless,≥4 cycles of chemotherapy can significantly improve the OS and PFS of patients with early-stage NKTCL.
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The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed,integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era,combined-modality treatment with systemic therapy is appropriate. A new concept,involved-site RT,defines the clinical target volume. For indolent NHL,often treated with RT alone,larger fields should be considered. Newer treatment techniques,including intensity modulated RT,breath holding,image guided RT,and 4-dimensional imaging,should be implemented,and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control.
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Objective To evaluate the value of radiotherapy following rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone ( R?CHOP )?based chemotherapy for patients with early?stage Waldeyer’ s ring diffuse large B?cell lymphoma ( WR?DLBCL). Methods Eighty?three patients diagnosed with early?stage WR?DLBCL who were admitted to our hospital from 2000 to 2013 were enrolled in the study. In these patients, twenty?five had stageⅠdisease and fifty?eight had stageⅡdisease. All patients received R?CHOP?based chemotherapy with ( n= 62 ) or without ( n= 21 ) involved?field radiotherapy ( Waldeyer’ s ring plus cervical lymph nodes ) . The overall survival ( OS ) , progression?free survival ( PFS) , and local?regional control ( LRC) rates were calculated using the Kaplan?Meier method. The univariate analysis was performed using the log?rank method. The multivariate analysis was performed using the Cox regression model. Results In all patients, the 5?year sample size was 18;the 5?year OS, PFS, and LRC rates were 89%, 84%, and 90%, respectively. According to the univariate analysis, patient age greater than 60 years, an increased lactate dehydrogenase level, Eastern Cooperative Oncology Group ( ECOG ) performance status no less than 2, and International Prognostic Index ( IPI ) no less than 2 were poor prognostic factors. Patient age greater than 60 years, a tumor size no less than 5 cm, ECOG performance status no less than 2, and IPI no less than 2 were influencing factors for PFS and LRC rates. In addition to the treatment with rituximab, patients treated with consolidative radiotherapy had significantly higher PFS and LRC rates (94% vs. 58%, P=0?003;100% vs. 61%, P=0?000) as well as slightly higher OS rate ( 9 4%vs . 7 1%, P=0?0 6 3 ) than those treated without radiotherapy . Conclusions Consolidative radiotherapy following R?CHOP?based chemotherapy significantly improves PFS, LRC, and probably OS rates for early?stage WR?DLBCL. This conclusion still needs to be confirmed by prospective studies with a large sample size.
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Objective To investigate the role of radiotherapy (RT) and prognostic factors in the combined modality treatment (CMT) of patients with stage ⅠE-ⅡE extranodal nasal type NK/T-cell lym-phoma. Methods From Dec. 1990 to Dec. 2006,177 patients who were diagnosed and treated in our hos-pital were retrospectively analyzed,induding 37 received chemotherapy (CT) alone ( median 4 cycles), 128 received CT (median 3 cycles) followed by RT (median 52 Gy) ,6 received RT alone (median 58 Gy) and 6 received RT ( median 54 Gy) followed by CT ( median 5 cycles). Results The overall response ( CR + PR) rate after initial CT was 60.8% compared with 83.8% after RT ( x2 = 28.63, P < 0.01 ). The 5-year overall survival (OS) and progress-free survival (PFS) rates were 46.2% and 36.8% ,respectively. The lo-cal control rates were 80.9% for RT ( alone or with CMT) and 50.0% for CT alone (x2 = 14.39, P < 0.01 ), and corresponding 5-year OS and PFS were 53.4% vs. 18.3 % ( x2 = 23.38, P < 0.01 ) and 45.0% vs. 10.9% (x2 =23.46,P <0.01 ),respectively. Compared with CT alone,the following definitive RT for patients who achieved response or not after initial CT significantly improved the local control [83.5%, 76.2% vs. 50.0% (x2 = 14.13,P <0.01;x2 =5.78,P <0.01)] and 5-year OS[56.2%,48.6% vs. 18.3%(x2 =28.87,P <0. 05;x2 =4.80,P <0.05)]. Concinsions Compared with CT alone, RT a-chieves better tumor response, local control and survival of patients not only with tumor response but also with local progression after CT. Definitive RT should be the reasonable choice of treatment for early stage extran-odal nasal type NK/T-cell lymphoma.
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Objective To evaluate the effects of nasal non-Hodgkin′s lymphoma(N-NHL) treated with chemotherapy alone, radiotherapy alone, chemotherapy plus radiotherapy and autologous peripheral blood stem cell transplantation(APBSCT) combined with total body irradiation(TBI);and to analyze the impact factors of prognosis. Methods 135 patients were treated between 1980 and 2000. All were confirmed by histopathology as N-NHL, including 122 T cell in origin, 12 B cell and 1 NK cell in origin. The main radiotherapy portal was set in front of the nose with a spade-like protrusion, supplement with a portal next to the ear on one side or both sides. Combined portal in facial cervical area was first used when there was invasion of the oropharynx. The median dose to the nasal cavity was 56.0Gy with a range of 35.2 to 75.5Gy, with added 30Gy to the primary lesion in two patients. Six patients received TBI combined with APBSCT, with 8Gy in the TBI group. Chemotherapy, given before or during after radiotherapy or alone, consisted of 2-6 cycles of COP, COPP, COMP, CHOP or COBDP. Prognostic factors were analyzed with Cox model. Results The local control rate was 12%,69%,76% and 83% in chemotherapy alone, radiotherapy alone, chemotherapy plus radiotherapy and APBSCT combined with TBI, respectively(P=0.057).The 5-year survival rate was 9%,52%,63% and 83%,respectively(P=0.032). Multi-factor analysis showed that tumor extension and treatment methods were the most important prognostic factors besides Ann-Arbor stage, but gender, pathology, age and symptoms had little effect on prognosis .Conclusions Chemotherapy plus radiotherapy group achieves a better survival rate than radiotherapy alone. It is helpful to evaluate prognosis to make more detail subareas on basis of local extensions in Ann Arbor staging system.For some N-NHL patients with good financial condition, APBSCT combined with TBI is a good choice.
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Objective To evaluate treatment effects and to determine the prognostic factors of primary orbital lymphoma. Methods From March 1984 to October 2000, 44 primary orbital lymphoma patients were admitted into our hospital, with 27 males and 17 females. Twenty-seven patients had eyelid or conjunctiva primary, and 17 patients orbit primary. Patient's age ranged from 14 to 86 years (median, 50.5years). According to the Ann Arbor Staging System, there were 40 ⅠEA, 4 ⅡEA lesions. Cobolt-60 ?ray was given first to the whole orbit to 30-35?Gy followed by 180 kv X-rays or 9 Mev ?-beam to the focus to a total dose of 41.0-51.5?Gy (median, 46.5?Gy). Kaplan-Meier method was used to analyze the survival. Log-rank test was used to detect the difference between groups.Results Only 1 patient failed from primary site and 5 patients from distant metastasis after radiotherapy. The 5-year and 10-year cause-specific survival rate were 90.9% and 84.5%, respectively. On univariate and multivariate analyses, eyelid or conjunctiva localization and Ann Arbor stage ⅠEA were independent favorable prognostic factors for survival. The 5-year survival was much higher in eyelid or conjunctiva patients than in orbital ones (96.3% vs 70.6%, P=0.013). The survival time was longer in stage Ⅰ than in stage Ⅱ (P=0.000). Neither the RT dose nor the age or sex influenced the outcome.Conclusions Localized orbital lymphoma can be well controlled with low-dose RT alone. Patients with eyelid or conjunctival localization and stage Ⅰ have better cause-specific survival.
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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.
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Objective To study the clinical and pathological characteristics, treatment results and prognosis of primary parotid non-Hodgkin's lymphoma (NHL). Methods All of our 21 patients received operative resection first and were histologically comfirmed as having T-cell (intermediate grade) and 20 B-cell lineage (2 high grade, 6 intermediate grade ,12 low grade) including 7 mucosa-associatied lymphoid tissue (MALT) phenotype. Ann Anbor stages were 16 stage Ⅰ E and 5 stage Ⅱ E lesions. All patients were treated by radiotherapy,of them 11 were also given 2～6 cycle chemotherapy. Results The overall 5-year survival rate was 77.0%. All 5 patients who died did so of distant involvement. Conclusions Our data show that MALT lymphoma can be present as a primary paroid NHL,although it is not included in the Working Formulation. Low-dose radiotherapy is of choice in the treatment. Patients with intermediate or high grade NHL should be given multi-modality therapy.
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Purpose: To detect the prognostic factors for early primary gastrointestinal non-Hodgkin's lymphoma treated by various treatments.Materials and Methods:32 aptients with stages Ⅰ and Ⅱ primary gastrointestinal non-Hodgkin's lymphoma treated from January, 1970 to November, 1987 were retrospectively reviewed. The primary sites of cancers were: 15 in stomach, 10 in ileocecal region, 4 in large bowel and 3 in small bowel. 24 patients underwent curative resection, 7 patients underwent incomplete resection and 1,unresectable. Postoperative radiotherapy was given to all patients.Among them, 14 patients received radiotherapy plus chemotherapy.Results: The overall 5-year survival rate was 59.4%(19/32).Conclusion: The main prognostic factors are the site of primary tumor, depth of invasion, stages and modalities of managements.Sex, age, and histologic does not influence the survivals.