Franklin J, Pluetschow A, Paus M, Specht L, Anselmo A-P, Aviles A, Biti G, Bogatyreva T, Bonadonna G, Brillant C, Cavalieri E, Diehl V, Eghbali H, Fermé C, Henry-Amar M, Hoppe R, Howard S, Meyer R, Niedzwiecki D, Pavlovsky S, Radford J, Raemaekers J, Ryder D, Schiller P, Shakhtarina S, Valagussa P, Wilimas J, Yahalom J
German Hodgkin Study Group, University of Cologne, Germany.
Ann Oncol. 2006 Dec;17(12):1749-60. doi: 10.1093/annonc/mdl302. Epub 2006 Sep 19.
Despite several investigations, second malignancy risks (SMR) following radiotherapy alone (RT), chemotherapy alone (CT) and combined chemoradiotherapy (CRT) for Hodgkin's lymphoma (HL) remain controversial.
We sought individual patient data from randomised trials comparing RT versus CRT, CT versus CRT, RT versus CT or involved-field (IF) versus extended-field (EF) RT for untreated HL. Overall SMR (including effects of salvage treatment) were compared using Peto's method.
Data for between 53% and 69% of patients were obtained for the four comparisons. (i) RT versus CRT (15 trials, 3343 patients): SMR were lower with CRT than with RT as initial treatment (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.98 and P = 0.03). (ii) CT versus CRT (16 trials, 2861 patients): SMR were marginally higher with CRT than with CT as initial treatment (OR = 1.38, CI 1.00-1.89 and P = 0.05). (iii) IF-RT versus EF-RT (19 trials, 3221 patients): no significant difference in SMR (P = 0.28) although more breast cancers occurred with EF-RT (P = 0.04 and OR = 3.25).
Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies.
尽管进行了多项研究，但单独放疗（RT）、单独化疗（CT）以及联合放化疗（CRT）治疗霍奇金淋巴瘤（HL）后的第二原发恶性肿瘤风险（SMR）仍存在争议。
我们从比较未经治疗的HL采用RT与CRT、CT与CRT、RT与CT或受累野（IF）放疗与扩大野（EF）放疗的随机试验中获取个体患者数据。使用Peto方法比较总体SMR（包括挽救治疗的影响）。
四项比较中获取了53%至69%患者的数据。（i）RT与CRT（15项试验，3343例患者）：作为初始治疗，CRT的SMR低于RT（比值比（OR）=0.78，95%置信区间（CI）=0.62 - 0.98，P = 0.03）。（ii）CT与CRT（16项试验，2861例患者）：作为初始治疗，CRT的SMR略高于CT（OR = 1.38，CI 1.00 - 1.89，P = 0.05）。（iii）IF-RT与EF-RT（19项试验，3221例患者）：SMR无显著差异（P = 0.28），尽管EF-RT后乳腺癌发生率更高（P = 0.04且OR = 3.25）。
HL初始治疗时在RT基础上加用CT可通过减少复发和挽救治疗需求降低总体SMR。晚期患者在CT基础上加用RT会使总体SMR略有增加。EF-RT后乳腺癌风险（而非一般的SMR）显著更高。将这些发现应用于当前治疗时需谨慎。
