title: [Treatment of non-Hodgkin's lymphomas in adults, stages III and IV with favorable histology : abstention or therapeutic aggressiveness?].
abstract: Within the inhomogeneous group of non Hodgkin's lymphomas, the natural history of lymphomas with favorable histologies, stages III and IV is uncommon; survival can be long, but the relapse rate is high, and finally the ten-year survival rate is poor. In order to improve these results, various proposals have been made. Presently, two main attitudes can be defined. The first one is based on data showing a better survival rate when a complete remission has been obtained; consequently, a very aggressive treatment scheme (for example an association of chemotherapy--including Adriamycin--and total body irradiation) is proposed. The second attitude is based on favorable results obtained by a "deferred treatment", the patients being treated only when the disease is symptomatic. Actually, the review of the literature shows that these two attitudes are complementary rather than antagonistic. For a young adult patient, essentially if histology is more "intermediate" than really "favorable" and if the patient presents with bulky tumoral masses, aggressive treatment must be proposed, because it is the only attitude able to achieve complete remission and therefore able to provide chances of long term survival. For an older patient, essentially with a very favorable histology and without any symptoms such an aggressive therapy appears too risky. "Light" treatments and occasionally "deferred treatment" can be proposed in these cases.
mesh_terms: D000367:Age Factors; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D005069:Evaluation Studies as Topic; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis
vernacular_title: Le traitement des lymphomes non hodgkiniens de l'adulte stades III et IV d'histologie favorable : abstention ou agressivité thérapeutique?