Vijayakumar S, Myrianthopoulos L C
Michael Reese/University of Chicago Center for Radiation Therapy, Department of Radiation and Cellular Oncology, University of Chicago, Illinois 60616.
Radiother Oncol. 1992 May;24(1):1-13. doi: 10.1016/0167-8140(92)90347-w.
Although radiotherapy cures a very high percentage of early stage patients with Hodgkin's disease (HD), there is a controversial dichotomy in the dose recommendations believed necessary to achieve greater than 95% local control: Whereas one school of thought is to administer 40-44 Gy, other reports claim equal results with about 36 Gy. It is also not clear what doses are required for various tumor cell burdens. The original recommendation of 40-44 Gy was derived from a retrospective analysis of in-field control of disease from mostly kilovoltage data three decades ago. However, there have been many advances in the evaluation of the extent of the disease and in the practice of radiotherapy since the 1960s. Many more dose-control studies have been published in recent years, necessitating a revisit to the dose-response question in HD. Here we have compiled the dose-control data from the 60s to the 90s and analyzed the original and the updated data with the same statistical method to see any differences. We also have performed similar analysis of dose-control information for subclinical disease, less than 6 cm and greater than 6 cm disease. Whereas original analysis (1040 sites at risk) suggested 98% in-field control with 44 Gy, our re-analysis including modern megavoltage data (4117 sites at risk) shows that similar in-field control rates could be achieved with 37.5 Gy. With megavoltage radiotherapy, the doses required for 98% in-field control for subclinical disease and disease of less than 6 cm and greater than 6 cm are, 32.4 Gy (1426 sites at risk), 36.9 Gy (1005 sites at risk) and 37.4 Gy (98 sites at risk), respectively. The results of current updated analysis will provide in-field disease control probabilities for different disease burdens and can serve as a guide in deciding dose prescriptions for practicing radiation oncologists.
尽管放射疗法能治愈很高比例的早期霍奇金病（HD）患者，但在实现大于95%的局部控制所需的剂量建议方面存在有争议的分歧：一种观点是给予40 - 44 Gy的剂量，而其他报告称约36 Gy的剂量能取得相同效果。目前也不清楚针对不同肿瘤细胞负荷需要何种剂量。最初40 - 44 Gy的建议是基于对三十年前大多千伏级数据的疾病野内控制情况的回顾性分析得出的。然而，自20世纪60年代以来，在疾病范围评估和放射治疗实践方面有了许多进展。近年来发表了更多的剂量 - 控制研究，因此有必要重新审视HD中的剂量 - 反应问题。在此，我们汇总了20世纪60年代至90年代的剂量 - 控制数据，并使用相同的统计方法分析了原始数据和更新后的数据，以查看是否存在差异。我们还对亚临床疾病、小于6 cm和大于6 cm疾病的剂量 - 控制信息进行了类似分析。最初的分析（1040个有风险部位）表明44 Gy可实现98%的野内控制，而我们纳入现代兆伏级数据的重新分析（4117个有风险部位）显示，37.5 Gy可实现相似的野内控制率。对于兆伏级放射治疗，亚临床疾病、小于6 cm和大于6 cm疾病实现98%野内控制所需的剂量分别为32.4 Gy（1426个有风险部位）、36.9 Gy（1005个有风险部位）和37.4 Gy（98个有风险部位）。当前更新分析的结果将为不同疾病负荷提供野内疾病控制概率，并可为放射肿瘤学医生确定剂量处方提供指导。
