併用化学療法が放射線療法に先行して治療されたWaldeyer咽頭輪原発病期IIびまん性非ホジキンリンパ腫の治療成績

Adriamycin-based Combination Chemotherapy Followed by Local Radiotherapy for Stage Ⅱ Diffuse Non-Hodgkin's Lymphoma Arising in Waldeyer's Ring

Ⅰ．はじめに

　従来病期II Waldeyer咽頭輪原発の非ホジキンリンパ腫（NHL）の放射線治療のみによる5年生存率は30〜40％程度で^1），到底満足のいく成績とはいえなかった。このような不良な成績の主な理由は，局所再発よりも2年以内に発症する遠隔転移によるものであり，かつ転移後の延命がほとんど期待できないという事実に基づくものであった^2）。

　近年進行型NHLに対する併用化学療法の進歩は目覚ましいものがあり，特に一部のびまん性大細胞型リンパ腫症例に治癒が期待できるまでになった^3）。また，Jonesら^4）はびまん性リンパ腫の治療にはアドリアマイシン（ADM）を含まない併用化学療法よりもADMを含んだ併用化学療法の方が有意に治療成績のよいことを報告した。

　Nineteen patients with stage II diffuse non-Hodgkin's lymphoma arising in Waldeyer's ring were initially treated with Adriamycin-based combination chemotherapy. Eighteen patients had large cell type and one had medium-sized cell type of lymphoma. Complete remission was obtained in 17 of 19 patients (89.5%). One of two patients who failed to attain complete remission had also complete disappearance of tumor temporarily during the early comes of the combination chemotherapy. Two patients who attained complete remission had recurrence. Two patients had died already, but one of these expired because of aspiration pneumonia during complete remission since he had radical resection of the cervical lymph nodes which induced recurrent nerve palsy. Dose of radiotherapy was reduced to 3,000 rads, and radiotherapy was delivered to only preexisting tumor sites during or after the initial combination chemotherapy. Side-effects were mainly gastrointestinal symptoms and bone marrow suppression.

　It is concluded that the initial combination chemotherapy is the same as effective as the initial radiotherapy in regard to the speed of tumor regression and complete remission rate, and produces a high rate of durable complete remissions.