Tarbell N J, Thompson L, Mauch P
Department of Radiation Therapy, Harvard Medical School, Boston, MA.
Int J Radiat Oncol Biol Phys. 1990 Feb;18(2):275-81. doi: 10.1016/0360-3016(90)90089-3.
A total of 590 patients with Stage IA-IIIB Hodgkin's disease received mantle irradiation at the Joint Center for Radiation Therapy between April 1969 and December 1984 as part of their initial treatment. Recurrence patterns as well as pulmonary, cardiac and thyroid complications were analyzed. Pulmonary recurrence was more frequently seen in patients with large mediastinal adenopathy (LMA); 11% of patients with LMA recurred in the lung in contrast to 3.1% with small or no mediastinal disease, p = 0.003. Hilar involvement, when corrected for size of mediastinal involvement, was not predictive of lung relapse. Patients with LMA also had a high rate of nodal relapse above the diaphragm (40%) following radiation therapy (RT) alone as compared to similarly treated patients with small or no mediastinal adenopathy (6.5%), p less than 0.0001. This risk of nodal recurrence was greatly reduced (4.7%) for LMA patients receiving combined radiation therapy and chemotherapy (CMT), p less than 0.0001. Sixty-seven patients (11%) with hilar or large mediastinal involvement received prophylactic, low dose, whole lung irradiation. No decrease in the frequency of lung recurrence was seen with the use of whole lung irradiation. Radiation pneumonitis was seen in 3% of patients receiving radiation therapy alone. In contrast, the use of whole lung irradiation was associated with a 15% risk of pneumonitis, p = 0.006. The risk of pneumonitis was also significantly increased with the use of chemotherapy (11%), p = 0.0001. Cardiac complications were uncommon with pericarditis being the most common complication (2.2%). Thyroid dysfunction was seen in 25% of patients and appeared to be age-related. These data suggest that the long-term complications of mantle irradiation are uncommon with the use of modern radiotherapeutic techniques. The use of prophylactic whole lung irradiation is no longer recommended since its use did not reduce pulmonary relapse but did increase the risk of pneumonitis. Chemotherapy is also associated with an increased risk of pneumonitis, however, its use in patients with large mediastinal adenopathy appears justified.
1969年4月至1984年12月期间，共有590例IA-IIIB期霍奇金病患者在联合放射治疗中心接受斗篷野照射，作为其初始治疗的一部分。分析了复发模式以及肺部、心脏和甲状腺并发症。肺部复发在有大纵隔淋巴结肿大（LMA）的患者中更常见；11%有LMA的患者肺部复发，而纵隔疾病小或无纵隔疾病的患者为3.1%，p = 0.003。校正纵隔受累大小后，肺门受累不能预测肺部复发。与单独接受放射治疗（RT）的纵隔淋巴结肿大小或无纵隔淋巴结肿大的患者（6.5%）相比，有LMA的患者在单独放射治疗后膈上淋巴结复发率也很高（40%），p < 0.0001。接受联合放射治疗和化疗（CMT）的LMA患者淋巴结复发风险大大降低（4.7%），p < 0.0001。67例（11%）有肺门或大纵隔受累的患者接受了预防性低剂量全肺照射。使用全肺照射未见肺部复发频率降低。单独接受放射治疗的患者中有3%发生放射性肺炎。相比之下，使用全肺照射发生肺炎的风险为15%，p = 0.006。使用化疗也显著增加了肺炎风险（11%），p = 0.0001。心脏并发症不常见，心包炎是最常见的并发症（2.2%）。25%的患者出现甲状腺功能障碍，且似乎与年龄有关。这些数据表明，使用现代放射治疗技术时，斗篷野照射的长期并发症并不常见。不再推荐使用预防性全肺照射，因为其使用并未降低肺部复发，但确实增加了肺炎风险。化疗也与肺炎风险增加有关，然而，在有大纵隔淋巴结肿大的患者中使用化疗似乎是合理的。
