睾丸弥漫大b 请大家帮忙看看谢谢了

艾菲 · 发表于 2013-2-26 20:23:15

父亲52岁，于12年11月被确诊非霍奇金淋巴瘤，免疫组化结果显示系弥漫大b细胞淋巴瘤，非特指，侵袭性，免疫组化染色：肿瘤细胞呈CD20(+)、CD79a（+），CD3ε（-），CD10（-），CD30（-），CD56（-），mum1（-），bc1-6（+），granzymeB（-），ki-67阳性率约为50%，EBER1/2原位杂交（-），并提示为非生发中心b细胞来源的肿瘤。
用ECHOP方案化疗一个疗程后白细胞降到100左右于是改用RCHOP方案化疗3个疗程，打算在做两个疗程的RCHOP，想问问洪飞和大家，这个疗程数量有什么问题没，另外化疗完成后医生说要进行腰穿、鞘注和放疗，不知道有必要没有，还有腰穿和鞘注对身体伤害大吗？想请大家帮帮忙，谢谢大家了

洪飞 · 发表于 2013-2-26 21:03:56

睾丸侵犯容易中枢转移，因此做腰穿鞘注化疗，降低中枢转移几率。

艾菲 · 发表于 2013-2-26 22:27:31

洪飞发表于 2013-2-26 21:03
睾丸侵犯容易中枢转移，因此做腰穿鞘注化疗，降低中枢转移几率。

谢谢洪飞我父亲这样的病预后是不是不好啊？五年生存率能有50%不呢

洪飞 · 发表于 2013-2-26 22:45:57

艾菲发表于 2013-2-26 22:27
谢谢洪飞我父亲这样的病预后是不是不好啊？五年生存率能有50%不呢

国际结外淋巴瘤研究组(IELSG）收集了50例1-2期的睾丸淋巴瘤（均为弥漫大B），RCHOP6个疗程，并鞘注4次，化疗结束后予对侧睾丸放疗(1期）或对侧睾丸及区域行淋巴结放疗（2期），3年总生存率，无进展生存率，无事件生存率分别为88%，82%和75%，3年的CNS的复发危险只有2.5%,无对侧睾丸复发。
你的5年要求50%我想问题不大！
附参考文献

原发性睾丸淋巴瘤诊断及治疗现状.pdf (436.79 KB, 下载次数: 851)
刚又查了下，找到了这个试验2011年的最新进展，中位随访5年的报告：

First-Line Treatment for Primary Testicular Diffuse Large B-Cell Lymphoma With Rituximab-CHOP, CNS Prophylaxis, and Contralateral Testis Irradiation: Final Results of an International Phase II Trial

Patients and Methods
Fifty-three patients (age 22 to 79 years) with untreated stage I or II PTL were treated with six to eight courses of rituximab added to cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) every 21 days (R-CHOP21); four doses of intrathecal methotrexate (IT-MTX) and radiotherapy (RT) to the contralateral testis (30 Gy) for all patients and to regional lymph nodes (30 to 36 Gy) for stage II disease.
Results
All patients received R-CHOP21, 50 received CNS prophylaxis, and 47 received testicular RT. With a median follow-up of 65 months, 5-year progression-free survival and overall survival rates were 74% (95% CI, 59% to 84%) and 85% (95% CI, 71% to 92%), respectively. （5年无进展生存与总生存率是74%和85%）Ten patients relapsed or progressed: two in lymph nodes, five in extranodal organs, and three in the CNS. The 5-year cumulative incidence of CNS relapse was 6% (95% CI, 0% to 12%). No contralateral testis relapses occurred. Ten patients died: lymphoma (n 6), secondary leukemia (n 2), heart failure (n 1), and gastric cancer (n 1). Grade 3 to 4 toxicities were neutropenia, 28%; infections, 4%; and neurologic, 13%. No deaths occurred as a result of toxicity.
Conclusion
This international prospective trial shows that combined treatment with R-CHOP21, IT-MTX, and
testicular RT was associated with a good outcome in patients with PTL. RT avoided contralateral
testis relapses, but CNS prophylaxis deserves further investigation.
J Clin Oncol 29:2766-2772. © 2011 by American Society of Clinical Oncology
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