Schlembach Pamela J, Wilder Richard B, Jones Dan, Ha Chul S, Fayad Luis E, Younes Anas, Hagemeister Fredrick, Hess Mark, Cabanillas Fernando, Cox James D
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030-4009, USA.
Cancer J. 2002 Sep-Oct;8(5):377-83. doi: 10.1097/00130404-200209000-00008.
The purpose of the study was to analyze the results with radiotherapy alone in a select group of asymptomatic adults with nonbulky, early-stage lymphocyte-predominant Hodgkin's disease.
Between 1963 and 1995, 36 patients with nonbulky stage IA (N = 27) or IIA (N = 9) supradiaphragmatic (N = 27) or subdiaphragmatic (N = 9) lymphocyte-predominant Hodgkin's disease were treated with radiotherapy alone. Eleven of the patients underwent laparotomy. Limited-field radiotherapy involving only one side of the diaphragm and extended-field radiotherapy encompassing both sides of the diaphragm were used in 28 and 8 cases, respectively. Median dose to involved areas was 40.0 Gy given daily in 20 2.0-Gy fractions. Salvage treatmentconsisted of MOPP (mechlorethamine, vincristine, prednisone, procarbazine), CVPP/ABDIC (cyclophosphamide, vinblastine, procarbazine and prednisone/doxorubicin, bleomycin, dacarbazine, lomustine, and prednisone), or ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) chemotherapy and/or involved-field radiotherapy.
Median follow-up was 8.8 years (range, 3.0-34.4 years). None of the 15 patients with supradiaphragmatic disease who received limited-field radiotherapy to regions that did not include the mediastinal or hilar nodes subsequently experienced relapse there. Only one of 20 patients who received supradiaphragmatic limited-field radiotherapy alone experienced relapse in the paraaortic nodes or spleen. The 5-year relapse-free and overall survival rates for the 20 patients with stage IA lymphocyte-predominant Hodgkin's disease treated with involved-field or regional radiotherapy were 95% and 100%, respectively. There were no cases of severe or life-threatening cardiac toxicity. No solid tumors have been observed in-field in patients treated with limited-field radiotherapy, even though they have been followed up longer than those treated with extended-field radiotherapy (median follow-up, 11.6 vs 5.5 years); two solid tumors have developed in-field in patients who received extended-field radiotherapy.
Involved-field or regional radiotherapy alone may be adequate in stage IA lymphocyte-predominant Hodgkin's disease patients. Longer follow-up will help to more clearly define the risks of cardiac toxicity and solid tumors that result from involved-field or regional radiotherapy, which appear to be low based on follow-up to date.
本研究的目的是分析一组选定的无症状、非肿块型、早期淋巴细胞为主型霍奇金淋巴瘤成年患者单纯放疗的结果。
1963年至1995年间，36例非肿块型ⅠA期（n = 27）或ⅡA期（n = 9）膈上（n = 27）或膈下（n = 9）淋巴细胞为主型霍奇金淋巴瘤患者接受了单纯放疗。其中11例患者接受了剖腹手术。仅累及一侧膈肌的局限野放疗和累及双侧膈肌的扩大野放疗分别应用于28例和8例患者。累及区域的中位剂量为40.0 Gy，每日分20次给予，每次2.0 Gy。挽救性治疗包括MOPP（氮芥、长春新碱、泼尼松、丙卡巴肼）、CVPP/ABDIC（环磷酰胺、长春花碱、丙卡巴肼和泼尼松/阿霉素、博来霉素、达卡巴嗪、洛莫司汀和泼尼松）或ABVD（阿霉素、博来霉素、长春花碱、达卡巴嗪）化疗和/或累及野放疗。
中位随访时间为8.8年（范围3.0 - 34.4年）。15例膈上疾病患者接受不包括纵隔或肺门淋巴结区域的局限野放疗后，均未在这些区域复发。仅1例单纯接受膈上局限野放疗的患者在腹主动脉旁淋巴结或脾脏复发。20例ⅠA期淋巴细胞为主型霍奇金淋巴瘤患者接受累及野或区域放疗后的5年无复发生存率和总生存率分别为95%和100%。未出现严重或危及生命的心脏毒性病例。接受局限野放疗的患者在野内未观察到实体瘤，尽管他们的随访时间比接受扩大野放疗的患者更长（中位随访时间分别为11.6年和5.5年）；接受扩大野放疗的患者有2例在野内发生了实体瘤。
对于ⅠA期淋巴细胞为主型霍奇金淋巴瘤患者，单纯累及野或区域放疗可能就足够了。更长时间的随访将有助于更清楚地确定累及野或区域放疗导致心脏毒性和实体瘤的风险，根据目前的随访情况，这些风险似乎较低。
