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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 whether the cervical lymph node NHL should be treated with the method of preventing the irradiation of the Wechsler’s ring. For cervical lymph node lymphoma, special attention should be paid to those excluded from the involvement of the Wech’s ring, mediastinum and axillary lymph nodes. In 106 NHL cases that were clinically confined to cervical lymph nodes, 17 patients received radiotherapy alone and 89 patients received radiation + chemotherapy. The chemotherapy regimen is CHOP or COMP. Prevention of exposure to the Wechsler ring is routinely performed with a face-neck joint field, and non-irradiation of the Welchman’s ring is mainly performed with a neck tangent field. Involvement of one side of the neck (phase I) in 90 cases, violation of both sides of the neck (phase II) in 16 cases. Eighty cases of infringement of the upper middle neck and pathology of moderately high grade were included in the analysis group. Results The 5-year survival rate and 5-year disease-free survival rate (DFS) were 58.4 % and 58.8 % respectively in the analysis and chemotherapy group, and the 5-year survival rate and the DFS were 5 6 7.4% and 6 3.8% (P values are all> 0. 0 5). The recurrence rates of the Wechsler’s ring in the whole group with and without preventing radiation were respectively 0% (0 43) and 1.6% (163). The recurrence rate of the Wechsler ring in both the preventive and non-preventive irradiation of the Wechsler ring was analyzed in the analysis group. They are 0 % (0 34) and 2.2 % (1 46), respectively. Conclusion The NHL of the cervical lymph nodes may not be able to prevent the exposure of the Wechsler ring, especially when chemotherapy + radiation therapy is used. Before treatment, we must routinely do the examination of Webster’s ring, especially the nasopharyngeal biopsy and CT examination to rule out the primary NHL of the Webster’s ring.