Song D Y, Jones R J, Welsh J S, Haulk T L, Korman L T, Noga S, Goodman S, Herman M, Mann R, Marcellus D, Vogelsang G, Ambinder R F, Abrams R A
Division of Radiation Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Oncology Center, Baltimore, MD 21231, USA.
Int J Radiat Oncol Biol Phys. 2003 Sep 1;57(1):166-71. doi: 10.1016/s0360-3016(03)00508-x.
In patients in whom bone marrow transplantation (BMT) fails, recurrence often occurs at sites known to have contained disease before initiating BMT. The purpose of this study was to find the maximal tolerable dose of locoregional irradiation (LRT) between 1000 and 2000 cGy that could be integrated with our Cytoxan-total body irradiation (TBI) BMT conditioning regimen in the treatment of lymphoma.
Patients had Hodgkin's or non-Hodgkin's lymphoma in chemotherapy-refractory relapse. All patients received LRT to a maximum of three sets of fields encompassing either all current or all previously known sites of disease. Cytoxan-TBI consisted of cyclophosphamide 50 mg/kg daily for 4 days followed by TBI of 1200 cGy given in four fractions.
Twenty-one patients were enrolled. Radiation Therapy Oncology Group Grade 3 in-field acute toxicity was observed in 1 patient at each dose level up to 1500 cGy and in 3 of 6 patients receiving 2000 cGy. Clinically evident late toxicities were limited to hypothyroidism and one second malignancy occurring outside the LRT fields.
Low-dose-rate, LRT with concurrent Cytoxan-TBI before BMT has acceptable rates of in-field toxicity for doses up to 1500 cGy in five fractions. This regimen safely permits the use of a total combined radiation dose of up to 2700 cGy during 2 weeks, with encouraging in-field response rates in treatment-refractory patients.
在骨髓移植（BMT）失败的患者中，复发常发生在开始BMT前已知存在疾病的部位。本研究的目的是找出在1000至2000厘戈瑞之间局部区域照射（LRT）的最大耐受剂量，该剂量可与我们的环磷酰胺-全身照射（TBI）BMT预处理方案联合用于淋巴瘤的治疗。
患者患有化疗难治性复发的霍奇金淋巴瘤或非霍奇金淋巴瘤。所有患者接受LRT，最多照射三组野，包括所有当前或所有先前已知的疾病部位。环磷酰胺-TBI方案为环磷酰胺50mg/kg，每日一次，共4天，随后分四次给予1200厘戈瑞的TBI。
共纳入21例患者。在剂量高达1500厘戈瑞的每个剂量水平，均有1例患者出现放射治疗肿瘤学组3级野内急性毒性反应；在接受2000厘戈瑞照射的6例患者中，有3例出现该反应。临床明显的晚期毒性反应仅限于甲状腺功能减退和1例发生在LRT野之外的第二原发恶性肿瘤。
在BMT前采用低剂量率LRT联合环磷酰胺-TBI，对于五分割剂量达1500厘戈瑞的情况，野内毒性反应发生率可接受。该方案安全地允许在2周内使用高达2700厘戈瑞的总联合放射剂量，在治疗难治性患者中野内反应率令人鼓舞。
