Hoskin P J, Smith P, Maughan T S, Gilson D, Vernon C, Syndikus I, Linch D C
Mount Vernon Cancer Center, Mount Vernon Hospital, Northwood, Middlesex, UK
Clin Oncol (R Coll Radiol). 2005 Feb;17(1):47-53. doi: 10.1016/j.clon.2004.07.004.
Involved field (IF) radiation was compared with extended field (EF) radiation in Hodgkin lymphoma (HL) to ascertain whether reduced radiation fields would reduce the late sequelae of radiation without compromising disease control and survival. A total of 603 patients with stage I or II HL were entered into this trial; laparotomy was carried out in 380 (63%) patients. Stage I or IIA disease patients were randomised to receive IF or EF comprising a mantle or inverted Y fields alone. Stage I and IIB patients were randomised between mantle or inverted Y fields and total nodal irradiation (TNI). The dose was 35 Gy to uninvolved sites and 40 Gy to involved sites. The median followup of surviving patients was 25.2 years with only 3.3% lost to follow-up. The treatment failure rate at 25 years in stage IA and IIA was 44% after EF and 54% after IF (P = 0.01); in stage I and IIB this was 80% (EF) and 82% (TNI) at 25 years. No difference in overall survival between the randomised groups was seen. The incidence of second malignancies was 21% after IF and 20% after EF with a slight excess of lung cancer in the EF group. No significant differences in the causes of death between the randomised arms have emerged. In conclusion, IF radiotherapy for stage I and IIA HL results in a 11% greater risk of relapse compared with EF but has no effect on overall survival, risk of second malignancy or cause of death at 25 years.
在霍奇金淋巴瘤（HL）中，对受累野（IF）放疗与扩大野（EF）放疗进行了比较，以确定缩小放疗野是否会在不影响疾病控制和生存的情况下减少放疗的晚期后遗症。共有603例I期或II期HL患者进入该试验；380例（63%）患者接受了剖腹手术。I期或IIA期疾病患者被随机分配接受仅包括斗篷野或倒Y野的IF或EF放疗。I期和IIB期患者在斗篷野或倒Y野与全淋巴结照射（TNI）之间进行随机分组。未受累部位的剂量为35 Gy，受累部位的剂量为40 Gy。存活患者的中位随访时间为25.2年，失访率仅为3.3%。IA期和IIA期25年时的治疗失败率在EF放疗后为44%，IF放疗后为54%（P = 0.01）；I期和IIB期25年时分别为80%（EF）和82%（TNI）。随机分组的两组之间总生存率无差异。IF放疗后第二原发恶性肿瘤的发生率为21%，EF放疗后为20%，EF组肺癌略多。随机分组的两组之间死亡原因无显著差异。总之，I期和IIA期HL的IF放疗与EF放疗相比，复发风险高11%，但对25年时的总生存率、第二原发恶性肿瘤风险或死亡原因无影响。
