Macdonald D A, Ding K, Gospodarowicz M K, Wells W A, Pearcey R G, Connors J M, Winter J N, Horning S J, Djurfeldt M S, Shepherd L E, Meyer R M
National Cancer Institute of Canada Clinical Trials Group, Queens University, Kingston, Ontario, Canada.
Ann Oncol. 2007 Oct;18(10):1680-4. doi: 10.1093/annonc/mdm287. Epub 2007 Sep 10.
In the National Cancer Institute of Canada Clinical Trials Group/Eastern Cooperative Oncology Group HD.6 trial, progression-free survival was better in patients randomized to therapy that included radiation, compared to doxorubicin (Adriamycin), bleomycin, vinblastine and dacarbazine (ABVD) alone. We now evaluate patterns of progression and subsequent outcomes of patients with progression.
After a median of 4.2 years, 33 patients have progressed. Two radiation oncologists determined whether sites of progression were confined within radiation fields. Freedom from second progression (FF2P) and freedom from second progression or death (FF2P/D) were compared.
Reviewers agreed for the extended (kappa = 0.87) and involved field (kappa = 1.0) analyses. Progression after ABVD alone was more frequently confined within both the extended (20/23 vs. 3/10; P = 0.002) and involved fields (16/23 vs. 2/10; P = 0.02). There was no difference in FF2P between groups [5-year estimate 99% (radiation) versus 96% (ABVD alone)] [hazard ratio (HR) = 3.14, 95% confidence interval (CI) 0.63-15.6; P = 0.14]; the 5-year estimates of FF2P/D were 94% in each group (HR = 1.04, 95% CI 0.41-2.63; P = 0.93).
Treatment that includes radiation reduces the risk of progressive Hodgkin lymphoma in sites that receive this therapy, but we are unable to detect differences in FF2P or FF2P/D.
在加拿大国家癌症研究所临床试验组/东部肿瘤协作组HD.6试验中，与单独使用多柔比星（阿霉素）、博来霉素、长春碱和达卡巴嗪（ABVD）相比，随机接受包括放疗在内治疗的患者无进展生存期更好。我们现在评估进展模式以及进展患者的后续结局。
中位随访4.2年后，33例患者出现进展。两名放射肿瘤学家确定进展部位是否局限于放疗野内。比较无二次进展生存期（FF2P）和无二次进展或死亡生存期（FF2P/D）。
审阅者在扩大野（kappa = 0.87）和受累野（kappa = 1.0）分析上达成一致。单独使用ABVD后的进展更常局限于扩大野（20/23对3/10；P = 0.002）和受累野（16/23对2/10；P = 0.02）。两组间FF2P无差异[5年估计值99%（放疗）对96%（单独ABVD）][风险比（HR）= 3.14，95%置信区间（CI）0.63 - 15.6；P = 0.14]；两组FF2P/D的5年估计值均为94%（HR = 1.04，95%CI 0.41 - 2.63；P = 0.93）。
包括放疗的治疗可降低接受该治疗部位霍奇金淋巴瘤进展的风险，但我们未能检测到FF2P或FF2P/D的差异。
