Connors J M, Noordijk E M, Horning S J
B.C. Cancer Agency, Vancouver Clinic, BC, Canada.
Hematology Am Soc Hematol Educ Program. 2001:178-93. doi: 10.1182/asheducation-2001.1.178.
This paper examines the evidence available to guide treatment decisions in three areas of Hodgkin's lymphoma management. In Section I Dr. Evert Noordijk describes evolving strategies for patients with early stage disease outlining the eras during which the focus has changed from initially accomplishing cure through refining and intensifying the treatment to one of maximizing cure rates and finally into a patient-oriented era in which the twin goals of maintaining high rates of cure and minimizing late toxicity are being achieved. In Section II Dr. Sandra Horning reviews the way in which the cooperative groups of North America and Europe have built upon initial observations from single centers to assemble the trials that have defined the treatment for advanced stage Hodgkin's lymphoma. Over a period of almost three decades, these well-constructed trials have defined a current standard of treatment, ABVD chemotherapy and are now investigating innovative approaches to move beyond this standard. She also indicates the need to appreciate diagnostic factors and the implications of prognostic factor models for the design and interpretation of clinical trials. In Section III Dr. Joseph Connors summarizes the evidence available to inform our choice of treatment for the uncommon but important entity of lymphocyte predominance Hodgkin's lymphoma. Once again, the guidance that can be derived from carefully conducted clinical investigation is used to address the issues surrounding choice of treatment, reasonable monitoring in long term follow-up and the clear-cut need to base diagnosis on objective immunohistochemical evidence.
本文探讨了霍奇金淋巴瘤治疗三个领域中可用于指导治疗决策的现有证据。在第一部分，埃弗特·诺德伊克博士描述了早期疾病患者不断演变的治疗策略，概述了治疗重点从最初通过改进和强化治疗实现治愈，到追求治愈率最大化，最终进入以患者为导向的时代的各个阶段，在这个时代，保持高治愈率和将晚期毒性降至最低这两个目标正在实现。在第二部分，桑德拉·霍宁博士回顾了北美和欧洲的合作组织如何在单中心初步观察的基础上开展试验，从而确定了晚期霍奇金淋巴瘤的治疗方案。在近三十年的时间里，这些精心构建的试验确定了当前的治疗标准——ABVD化疗，目前正在研究超越这一标准的创新方法。她还指出，在设计和解释临床试验时，需要重视诊断因素以及预后因素模型的意义。在第三部分，约瑟夫·康纳斯博士总结了可用于指导我们选择治疗淋巴细胞为主型霍奇金淋巴瘤这一罕见但重要实体的现有证据。同样，通过精心开展的临床研究得出的指导意见被用于解决围绕治疗选择、长期随访中的合理监测以及基于客观免疫组化证据进行诊断的明确需求等问题。
