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目的 :探讨恶性肉芽肿的临床特征、诊断及治疗。方法 :对 1 0 1例恶性肉芽肿的临床资料作回顾性分析 ,其中 68例单纯放射治疗 ,放射剂量为 45～ 65Gy/ 5～ 6周 ;38例行综合治疗 (放射治疗 +化疗 ) ,化疗方案有CCNU、COMP和CHOP。结果 :该病临床表现复杂 ,首次确诊率仅为 33 .7% ,总的 3 ,5 ,1 0年生存率分别为78.2 % ,56 .1 %和 39.7%。单纯放射治疗和采用CHOP ,CCNU或COMP方案综合治疗的 5年生存率分别为60 .3 % ,64 .7% ,40 %和 33 .3 % ,前两者差异无显著性意义 (P >0 .0 5)。病变仅侵犯 1个部位者生存率明显高于侵犯≥ 2个部位者 (P <0 .0 0 1 )。有全身症状者生存率明显低于无发热盗汗者 (P <0 .0 5)。放射治疗剂量为 50～ 60GY组生存率明显高于 <50GY组 (P <0 .0 5) ,局部邻近复发率为 2 0 .8%。结论 :该病易误诊 ,早期确诊及治疗可提高疗效 ,对单发性且无全身症状者可作单纯放射治疗。放射剂量宜为 50～ 60GY。对病变侵犯多个部位且有全身症状者建议作CHOP方案的综合治疗。
Objective: To investigate the clinical features, diagnosis and treatment of malignant granuloma. Methods: The clinical data of 101 cases of malignant granuloma were retrospectively analyzed. Among them, 68 cases were treated with radiotherapy alone at a dose of 45-65 Gy / 5-6 weeks; 38 cases were treated with radiotherapy + chemotherapy, Programs are CCNU, COMP and CHOP. Results: The clinical manifestations of the disease were complicated. The first confirmed diagnosis rate was only 33.7%. The overall survival rates in 3, 5, and 10 years were 78.2%, 56.1% and 39.7%, respectively. The 5-year survival rates of simple radiotherapy and CHOP, CCNU or COMP regimen were 60.3%, 64.7%, 40% and 33.3% respectively, with no significant difference between the two groups (P> 0 .0 5). Survival rate of patients with lesions invading only one site was significantly higher than those with more than two sites (P <0.01). Patients with systemic symptoms had significantly lower survival rates than those without fever (P <0.05). The survival rate of patients treated with radiotherapy at 50-60 Gy was significantly higher than that at <50 Gy (P <0.05), and the local recurrence rate was 20.8%. Conclusion: The disease is easy to misdiagnosis, early diagnosis and treatment can improve the efficacy of single and no systemic symptoms can be used for simple radiotherapy. Radiation dose should be 50 ~ 60GY. On the lesions of multiple sites and have systemic symptoms suggested CHOP program comprehensive treatment.