Combined modality therapy in malignant lymphomas.
Combined modality therapy in malignant lymphomas.
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恶性淋巴瘤的综合治疗。
DOI：
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发表时间：
1977
期刊：
影响因子：
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通讯作者：
H. Kaplan
中科院分区：
文献类型：
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作者：
E. Glatein;S. Donaldson;S. Rosenberg;H. Kaplan
非霍奇金淋巴瘤患者的治疗仍存在争议。 Rappaport 分类系统已确立其在区分相对有利的疾病（即结节性或滤泡性淋巴瘤）与相对不利的疾病（即弥漫性淋巴瘤）方面的临床价值。尽管由于复合淋巴瘤的存在和给定淋巴结中的一系列结节性而导致给定患者存在多种组织学问题，但尚未证明新的分类优于 Rappaport 系统。回顾了放疗和化疗的相对作用。当使用足够的剂量和体积时，辐射的主要作用似乎是控制可检测到的疾病。化疗的主要作用似乎是根除肿瘤微病灶。联合治疗方法的随机研究尚未得出明确的证据表明辅助化疗对组织学不良的 I 期和 II 期疾病有益。在不利组织学类型的 III 期和 IV 期疾病中添加辅助放疗似乎会产生一些改善。对于具有良好组织学类型的 IV 期范围的患者，积极的治疗方案尚未显示出比保守治疗有任何显着优势。本文强调在每项非霍奇金淋巴瘤研究中都需要专家的血液病理学解释。
The treatment of patients with non-Hodgkin's lymphomas remains controversial. The Rappaport classification system has established its clinical value in distinguishing relatively favorable disease (ie, nodular or follicular lymphoma) from relatively unfavorable disease (ie, diffuse lymphoma). Despite the problems of multiple histologies in a given patient posed by the existence of composite lymphomas and by a spectrum of nodularity in a given node, no newer classification has yet proved superior to the Rappaport system. The relative roles of radiotherapy and chemotherapy are reviewed. The primary role of radiation appears to be the control of detectable disease, when adequate doses and volumes are employed. The primary role of chemotherapy appears to be the eradication of microfoci of tumor. Randomized studies of combined modality approaches have produced no definitive evidence of benefit from adjuvant chemotherapy in stage I and II disease of unfavorable histology. The addition of adjuvant radiotherapy in stage III and IV disease of unfavorable histologic types appears to produce some improvement. Aggressive treatment regimes have yet to show any significant advantage over more conservative treatment in patients with favorable histologic types of stage IV extent. This paper emphasizes the need for expert hematopathologic interpretation in every study of non-Hodgkin's lymphoma.