联合化疗加低剂量受累野放疗用于早期临床分期霍奇金淋巴瘤

Combination chemotherapy plus low-dose involved-field radiotherapy for early clinical stage Hodgkin's lymphoma.

作者信息

Vassilakopoulos Theodoros P, Angelopoulou Maria K, Siakantaris Marina P, Kontopidou Flora N, Dimopoulou Maria N, Kokoris Styliani I, Kyrtsonis Marie Christine, Tsaftaridis Panayiotis, Karkantaris Christos, Anargyrou Konstantinos, Boutsis Dimitrios E, Variamis Eleni, Michalopoulos Thymios, Boussiotis Vassiliki A, Panayiotidis Panayiotis, Papavassiliou Constantinos, Pangalis Gerassimos A

机构信息

Haematology Section, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.

出版信息

Int J Radiat Oncol Biol Phys. 2004 Jul 1;59(3):765-81. doi: 10.1016/j.ijrobp.2003.11.029.

DOI:10.1016/j.ijrobp.2003.11.029

PMID:15183480

Abstract

PURPOSE

To present our long-term experience regarding the use of chemotherapy plus low-dose involved-field radiotherapy (IFRT) for clinical Stage I-IIA Hodgkin's lymphoma.

METHODS AND MATERIALS

We analyzed the data of 368 patients. Of these, 66 received mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and 302 received doxorubicin (or epirubicin), bleomycin, vinblastine, and dacarbazine [A(E)BVD]. Patients with complete remission or very good partial remission were scheduled for low-dose IFRT (< or =3200 cGy).

RESULTS

The 10-year failure-free survival (FFS) and overall survival (OS) rate was 85% and 86%, respectively. A(E)BVD-treated patients had superior 10-year FFS and OS rates compared with MOPP-treated patients (87% vs. 75%, p = 0.009; and 93% vs. 71%, p = 0.0004, respectively). Only 10 of 41 relapses had any infield (irradiated) component. Of the complete responders/very good partial responders treated with low-dose IFRT, those who received <2800 cGy had inferior FFS but similar OS as those who received 2800-3200 cGy. Adverse prognostic factors for FFS included age > or =45 years, leukocytosis > or =10 x 10(9)/L, and extranodal extension. Secondary acute leukemia developed after MOPP with or without salvage therapy (n = 6) or after ABVD plus salvage therapy (n = 2). None of the nine secondary solid tumors developed within the RT fields.

CONCLUSION

IFRT at a dose of 2800-3000 cGy is highly effective in clinical Stage I-IIA HL patients who achieved a complete response or very good partial response with A(E)BVD. The long-term toxicity with respect to secondary malignancies appears to be acceptable.

摘要

目的

介绍我们使用化疗联合低剂量累及野放疗（IFRT）治疗临床Ⅰ - ⅡA期霍奇金淋巴瘤的长期经验。

方法和材料

我们分析了368例患者的数据。其中，66例接受了氮芥、长春新碱、丙卡巴肼和泼尼松（MOPP）方案治疗，302例接受了阿霉素（或表柔比星）、博来霉素、长春花碱和达卡巴嗪[A（E）BVD]方案治疗。完全缓解或非常好的部分缓解的患者计划接受低剂量IFRT（≤3200 cGy）。

结果

10年无失败生存率（FFS）和总生存率（OS）分别为85%和86%。与接受MOPP治疗的患者相比，接受A（E）BVD治疗的患者10年FFS和OS率更高（分别为87%对75%，p = 0.009；93%对71%，p = 0.0004）。41例复发患者中只有10例有任何野内（照射）成分。在接受低剂量IFRT治疗的完全缓解者/非常好的部分缓解者中，接受<2800 cGy照射的患者FFS较差，但OS与接受2800 - 3200 cGy照射的患者相似。FFS的不良预后因素包括年龄≥45岁、白细胞增多≥10×10⁹/L和结外侵犯。MOPP治疗后无论有无挽救治疗（n = 6）或ABVD加挽救治疗后（n = 2）发生了继发性急性白血病。9例继发性实体瘤均未在放疗野内发生。