濾胞性リンパ腫の診断と治療―消化管原発濾胞性リンパ腫の治療―積極的に治療を行う立場から

Treatment : Watchful Waiting for Follicular Lymphoma of the Gastrointestinal Tract

消化管原発濾胞性リンパ腫は，十二指腸下行部に白色顆粒が集簇した病変として発見され，小腸にも病変が存在することが多い．無症状で臨床病期がLugano国際会議分類I期であることが多く，積極的な治療を行うべきかwatchful waitingとするべきか，統一された見解はない．自験例では，十二指腸に病変が限局した3例では放射線治療30Gyで完全寛解が得られている．R-CHOP療法を行った21例において，1例で寛解後の再発を認めたが，その他の20例では完全寛解を維持できている．watchful waitingとした17例中2例（12％）で増悪を認めR-CHOP療法を施行している．本稿では，自施設での経験をもとに，現時点における消化管原発濾胞性リンパ腫に対する治療に関する筆者らの見解を述べる．

　FLs（follicular lymphomas）of the GI（gastrointestinal）are relatively rare, and most of them are diagnosed as clusters of whitish granular lesions in the second portion of the duodenum. Involvement of the jejunum and/or the ileum is often observed in GI-FL. As a result, these tumors are mostly diagnosed as stage I and several patients have no symptoms ; therefore, the appropriate strategy for treatment of GI-FL is a controversial topic. There are several opinions favoring chemotherapy, surgical intervention, radiotherapy, or“watchful waiting.”We evaluated 43 cases of primary GI-FL. CR（complete regression）was achieved with radiation therapy at the dose of 30 Gy in 3 cases with the lesion confined to the duodenum. We administered 5-6 rounds of chemotherapy, including rituximab administration, in 27 patients. CR was achieved in all cases, but there was 1 case of recurrence. We opted for watchful waiting in 17 patients, and in the process, 2 patients（13％）, with FL stages II1 and II2, presented with signs of PD（progressive disease）. They received chemotherapy and achieved CR. In this manuscript, we present arguments for and against watchful waiting and active intervention in GI-FL.