RESUMEN
BACKGROUND & OBJECTIVE: Primary mediastinal large B-cell lymphoma (PMBCL) is an uncommon subtybe of diffuse large B-cell lymphoma (DLBCL). This study was to investigate optimal treatment and prognostic factors of PMBCL by analyzing its clinical features. METHODS: Clinical records of 24 PMBCL patients, treated in Fujian Provincial Tumor Hospital from 1995 to 2005, were reviewed. RESULTS: Of the 24 patients, 16 were men and 8 were women, aged from 12 to 81; 20 were at stage I-II, 1 at stage III, and 3 at stage IV; 13 had bulk disease; 10 had superior vena cava syndrome; 14 had contiguous infiltration; 15 had lacate dehydrogenase elevation; 11 received chemoradiotherapy, 10 received chemotherapy alone, and 3 received radiotherapy alone; 10 achieved complete remission (CR) after scheduled treatment, 12 achieved partial remission (PR), 1 had stable disease and 1 had progressive disease. The median survival time was 89 months; the 3-year overall survival rate was 69%. At the end of follow-up, the patients initially achieved CR were all alive. International prognostic index (IPI) did not predict survival in this analysis, while bulk disease predicted poor survival. CONCLUSIONS: PMBCL has a male dominance in this analysis. Its clinical presentation is critical. Prompt diagnosis is needed. Anthracycline-based chemotherapy with radiotherapy may lead to favorable outcome. The patients with bulk disease have poor survival.
Asunto(s)
Linfoma de Células B Grandes Difuso/terapia , Neoplasias del Mediastino/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Diagnóstico Diferencial , Femenino , Humanos , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/mortalidad , Masculino , Neoplasias del Mediastino/diagnóstico , Neoplasias del Mediastino/mortalidad , Persona de Mediana Edad , PronósticoRESUMEN
BACKGROUND & OBJECTIVE: Intracavitary hyperfractionated brachytherapy is one of the main methods in brachytherapy for early stage nasopharyngeal carcinoma (NPC). We developed the parapharyngeal space interstitial brachytherapy for the NPC patients with residual tumor in the parapharyngeal space after external radiotherapy, and used hyperfractionated brachytherapy as a boosting radiation for the locally advanced patients who have no tumor invasion in the base of skull. This study was to analyze the long-term efficacy of external radiotherapy plus intracavitary hyperfractionated brachytherapy on NPC, and explore the clinical value and suitable dose. METHODS: From Jan. 1998 to Dec. 2002, 352 NPC patients were treated by external radiotherapy plus intracavitary hyperfractionated brachytherapy in Fujian Provincial Tumor Hospital. The parapharyngeal space interstitial brachytherapy was used in the patients with residual tumor in the parapharyngeal space after external radiotherapy. The external irradiation dose varied from 50 to 70 Gy. Brachytherapy was delivered by 2.5-3.0 Gy per fraction, and 2 fractions per day with an interval of 6 h; the total dose ranged from 5 to 32 Gy with a median of 17 Gy. RESULTS: The overall 1-, 2-, 3-, and 5-year disease-free survival rates were 97.0%, 91.3%, 87.6%, and 84.7%, respectively. The 5-year survival rate was significantly higher in stage I-II patients than in stage III-IV patients (88.2% vs. 79.2%, P=0.016)û but the local control rate was similar in the 2 groups (94.1% vs. 91.7%). Thirty-two (9.4%) patients had radiation injury at the lower cranial nerve. CONCLUSION: External radiotherapy plus intracavitary and interstitial hyperfractionated brachytherapy can improve local control rate and survival rate of NPC, but the occurrence rate of radiation injury at the lower cranial nerve is higher in the patients with parapharyngeal space involvement than in other patients.