국한성 두경부 비호지킨스 림프종 환자에서의 다방면치료

• 영문명: Multimodal Approaches in the Patients with Stage Ⅰ, Ⅱ Non-Hodgkin's Lymphoma of the Head and Neck
• 발행기관: 대한방사선종양학회
• 저자명: 표홍렬(Hong Ryull Pyo) 서창옥(Chang Ok Suh) 김귀언(Gwi Eon Kim) 노재경(Jae Kyung Rho)
• 간행물 정보: 『대한방사선종양학회지』제13권 제2호, 129~142쪽, 전체 14쪽
• 주제분류: 의약학 > 종양학
• 파일형태: PDF
• 발행일자: 1995.06.30

영문 초록

Purpose : Traditionally the patients with early stage non-hodgkin's lymphoma of the head and neck was treated with radiotherapy. But the results were not satisfactory due to distant relapse. Although combined treatment with radiotherapy and chemotherapy was tried with some improved results and chemotherapy alone was also tried in recent years, the choice of treatment for the patients with early stage non-Hodgkin's lymphoma of the head and neck has not been defined. Therefore, in order to determine the optimum treatment method, we analysed retrospectively the outcomes of the patients with Ann Arbor stage Ⅰ and Ⅱ non-Hodgkin's lymphoma localized to the head and neck who were treated at Severance Hospital. Materials and Methods : 159 patients with stage Ⅰ and Ⅱ non-Hodgkin's lymphoma localized to the head and neck were treated at out hospital from January. 1979 to December. 1992. Of these patients, 114 patients whose primary sites were Waldeyer's ring or nodal region and received prescribed radiation dose and/or more than 2 cycles of chemotherapy were selected to analyze the outcomes according to the treatment methods (radiotherapy alone, chemotherapy alone, and combined treatment with radiotherapy and chemotherapy). Results : Five year overall actuarial survival of the patients whose primary site was Waldeyer's ring was 62.5% and that of the patients whose primary site was nodal region was 53.8%. There was no statistically significant difference between survivals of both groups. Initial response rate to radiotherapy, chemotherapy, and combined treatment was 92%, 83%, 94% respectively, and 5 year relapse free survival was 49.9%, 52.4%, 58.5% respectively (statistically not significant). In the patients with stage Ⅰ, 3 year relapse free survival of chemotherapy alone group was 75% and superior to other treatment groups. In the patients with stage Ⅱ, combined treatment group revealed the best result with 60.1% of 3 year relapse free survival. The effect of sequential schedule of each treatment method in the patients who were treated by combined modality was analyzed and the sequence of primary chmotherapy+radiotherapy+maintenance chemotherapy showed the best result (3 year relapse free survival was 79.1%). There was no significant survival difference between BACOP regimen and CHOP regimen. REsponse to treatment was only one significant (p<0.005) prognostic factor on univariate analysis and age and mass size was marginally significant (p<0.1). On multivariate analysis age (p=0.026) and mass size (p=0.013) were significant prognostic factor for the relapse free survival. Conclusion : In summary, the patients, who have non-Hodgkin's lymphoma fo the head and neck with stage Ⅰ and mass size smaller than 10cm, can be treated by chemotherapy alone, but remainder should be treated by combined treatment method and the best combination schedule was the sequence of initial chemotherapy followed by radiotherapy and maintenance chemotherapy.

키워드

Head and neck lymphoma Radiotherapy Chemotherapy Combined treatment Multivariate analysis