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Lymphoma with Intraspinal Extramedullary Involvement as Initial Presentation



目的:回顧脊椎或神經根壓迫為初始症狀淋巴瘤患者的治療經驗。 材料與方法:從1977至1996年二十年間,本院共有9例以脊椎或神經根壓迫為初始症狀之淋巴瘤患者。其中只有6例原發的硬膜外侵犯屬第一期,而第二、三、四期各1例。除了1例何杰金氏淋巴瘤及1例淋巴肉瘤外,其餘病患皆是非何杰金氏淋巴瘤,以工作分類來分多屬中間級。減壓手術後,兩位病例接受放射治療;1位病例接受化學治療;其餘6例接受合併放射及化學治療。 結果:病患於前驅期會先有1到10個月的背痛,接著發生急遽惡化之脊髓壓迫症狀。治療後,5位病患的腫瘤完全緩解,爾後其中1位死於化療之副作用,1位死於其他疾病,1位轉移,只有2位至今無疾病復發跡象。而4位部分緩解的病患則全因此疾病亡故。 結論:以硬膜上或硬膜內壓迫為初始症狀之淋巴瘤是一種進行快速的疾病。積極的處理合併手術、放射及化學治療,以獲得較好的局部控制及存活率是一般的建議。

Parallel abstracts

Purpose: To review the treatment results of lymphoma with initial presentation of spinal cord or cauda equina compression. Materials and Methods: Lymphoma with cord or cauda equina compression as initial presentation were seen in 9 patients in our hospital between 1977 to 1996. Among them, six patients presented with stage IE primary spinal epidurl involvement, whereas the others has stage ⅡE, ⅢE and ⅣE disease (1 patient each). Except for one Hodgkin's lymphoma and one lymphosarcoma, all of the other patients were non-Hodgkin's lymphoma with unfavorable histologic grading, mostly were the intermediate grade classification according to the Warking Formulation. After decompression surgery, the subsequent treatments of these patients were radiotherapy (2 patients), chemotherapy (1 patient), and combination of both treatment modalities (6 patients). Results: A prodromal phase of local back pain occurred in all patients, with duration from 1 to 10 months, followed by a second phase of rapidly progressive signs of cord compression. After treatment, 5 patients achieved complete remission: among with, one died of chemotherapy complication, one died of intercurrent disease, one had distant metastasis, and only 2 patients remained disease free. The other 4 patients who got partial remission were all dead of this disease. Conclusion: Lymphoma with spinal epidural or intradural involvement at initial presentation is an aggressive disease. An intensive treatment combination with irradiation, chemotherapy, and surgery, is suggested in order to achieve good local control and longterm survival.