摘要：

The progress in Hodgkin's disease has created a challenge to improve the management of all other lymphomata. This paper deals with the evaluation of radiation therapy as a primary treatment modality. All the important histoclinical features which affect prognosis were considered in the attempt to clarify the indications for radiation therapy. Radiotherapy alone appears to be adequate for the majority in Stage IA lymph node and Stages IA and IIA extranodal presentations, but primary chemotherapy may be indicated for the exceptional case with 2 or more unfavourable prognostic influences present. Primary radiation therapy and primary chemotherapy appear to be equally effective in effecting prolonged remission in the 'favorable' Stage IIA and IIIA lymph node presentations. In the less favorable presentations, chemotherapy is the initial approach and the subsequent radiation therapy is considered supplemental. In Stage IIIA extranodal presentations the sequence of the 2 modalities appears to depend on the site of primary disease. In Stage IIIA disease confined to the abdomen, primary radiation therapy may be considered. In all other sites, particularly when the regression of the involvement can be observed, primary chemotherapy is advised. The optimum radiation tumor dose is influenced by the histology, the extent of local disease, the tissue volume to be treated and the observed rate of regression during therapy; hence, the wide range of tumor doses quoted in the paper. When irradiation is required to supplement combination chemotherapy, all the tumor doses quoted can be reduced to approximately 2/3 of the average dosage required for primary radiation. The variables in the spectrum of presentations in the lymphomata are too numerous to allow a rigid routine management according to anatomical stage in either lymph node or extranodal patterns. A compromise is frequently required, especially for those with unusual features or a concurrent disease or disability. The present concept of the role of radiation therapy in the lymphomata other than Hodgkin's disease may be revised in the future when the long term results of prospective clinical trials become available.

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