Conservative management in primary genital lymphomas: The role of chemotherapy
Conservative management in primary genital lymphomas: The role of chemotherapy
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DOI：
10.1016/j.ygyno.2006.08.024
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发表时间：
2007-02-01
影响因子：
4.7
通讯作者：
Mangioni, Costantino
中科院分区：
文献类型：
--
作者：
Signorelli, Mauro;Maneo, Andrea;Mangioni, Costantino
背景。女性生殖器淋巴瘤是一种极为罕见的疾病，占妇科癌症的不到0.5%，占所有非霍奇金淋巴瘤的1.5%。由于发病率低，对其治疗尚无广泛接受的共识。文献资料支持以放疗为基础的治疗原发性生殖器淋巴瘤I-II期的病例。化疗作为新辅助治疗或单独治疗的作用仍有待确定。本文回顾了我院1984 ~ 2003年收治的19例生殖器淋巴瘤患者的治疗情况。宫颈淋巴瘤9例，阴道淋巴瘤3例，宫颈-阴道淋巴瘤1例，外阴淋巴瘤2例，卵巢淋巴瘤4例。7例为IE， 9例为IE， 1例为IE， 2例为IVE。总体而言，18/19例患者采用化疗，其中12例建议化疗为一线治疗，7例建议手术治疗（6例建议化疗）。在9/12的患者中，单次化疗获得完全缓解（CR）；9例手术患者中3例病理完全缓解（pCR）。3例患者部分缓解（PR），需放疗。4例患者中有3例在手术不完全消肿后化疗获得CR。单独化疗组有2例复发。两人都通过进一步的化疗得以挽救。只有1例患者在手术和化疗后因肿瘤死亡。独家化疗的使用不仅在生存率方面，而且在减少放射治疗的需要方面都取得了令人鼓舞的结果。在原发性生殖器淋巴瘤I-II期的患者中，选择有妊娠意愿的患者，可以尝试基于单纯化疗的保守治疗。(c) 2006年爱思唯尔公司。版权所有。
Background. The female genital lymphomas are an extremely rare disease accounting for less than 0.5% of gynecological cancers and for 1.5% of all NHL. Because of their low incidence there is no widely accepted consensus on its treatment. Literature data support a radiotherapy-based treatment in case of primary genital lymphomas stages I-II. The role of chemotherapy as neoadjuvant or exclusive treatment is still to be defined.Methods. From 1984 to 2003, the treatments in our institution of 19 patients with genital lymphoma were reviewed. Nine women presented with cervical, 3 with vaginal, I with cervical-vaginal, 2 with vulvar and 4 with ovarian lymphoma. Seven were staged IE, nine IIE, one IIIE and two IVE. As a whole, chemotherapy was used in 18/19 cases: chemotherapy was proposed as first line treatment in 12 cases, while surgery in 7 (followed by chemotherapy in 6 cases).Results. Primary chemotherapy alone obtained a complete response (CR) in 9/12 patients; pathological complete response (pCR) was confirmed in 3 operated patients out of 9. Partial response (PR) was observed in 3, requiring radiotherapy. Chemotherapy obtained CR after incomplete surgical debulking in 3 out of 4 cases. Two patients relapsed in the group treated with chemotherapy alone. Both have been salvaged by further chemotherapy. Only one patient deceased due to her tumor after surgery and chemotherapy.Conclusion. The use of exclusive chemotherapy obtained promising results not only as regards survival rates but also for reducing the need of radiotherapy. A conservative management based on exclusive chemotherapy in primary genital lymphoma stages I-II may be attempted in selected patients desiring pregnancy. (c) 2006 Elsevier lnc. All rights reserved.