Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
Int J Radiat Oncol Biol Phys. 2011 May 1;80(1):199-205. doi: 10.1016/j.ijrobp.2010.09.007.
To assess the clinical outcome of the involved-node radiotherapy (INRT) concept using modern radiation treatments (intensity-modulated radiotherapy [IMRT] or deep-inspiration breath-hold radiotherapy [DIBH) in patients with localized supradiaphragmatic Hodgkin lymphoma.
All but 2 patients had early-stage Hodgkin lymphoma, and they were treated with chemotherapy prior to irradiation. Radiation treatments were delivered using the INRT concept according to European Organization for Research and Treatment of Cancer guidelines. IMRT was performed with the patient free-breathing. For the adapted breath-hold technique, a spirometer dedicated to DIBH radiotherapy was used. Three-dimensional conformal radiotherapy was performed with those patients.
Fifty patients with Hodgkin lymphoma (48 patients with primary Hodgkin lymphoma, 1 patient with recurrent disease, and 1 patient with refractory disease) entered the study from January 2003 to August 2008. Thirty-two patients were treated with IMRT, and 18 patients were treated with the DIBH technique. The median age was 28 years (range, 17-62 years). Thirty-four (68%) patients had stage I - (I-IIA) IIA disease, and 16 (32%) patients had stage I - (I-IIB) IIB disease. All but 3 patients received three to six cycles of adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD). The median radiation doses to patients treated with IMRT and DIBH were, respectively, 40 Gy (range, 21.6-40 Gy) and 30.6 Gy (range, 19.8-40 Gy). Protection of various organs at risk was satisfactory. Median follow-up was 53.4 months (range, 19.1-93 months). The 5-year progression-free and overall survival rates for the whole population were 92% (95% confidence interval [CI], 80%-97%) and 94% (95% CI, 75%-98%), respectively. Recurrences occurred in 4 patients: 2 patients had in-field relapses, and 2 patients had visceral recurrences. Grade 3 acute lung toxicity (transient pneumonitis) occurred in 1 case.
Our results suggest that patients with localized Hodgkin lymphoma can be safely and efficiently treated using the INRT concept and modern radiation treatment techniques such as IMRT and DIBH.
评估采用现代放疗技术（调强放疗 [IMRT] 或深吸气屏气放疗 [DIBH]）对局限性膈上霍奇金淋巴瘤患者施行累及野放疗（INRT）的临床结果。
除 2 例患者外，所有患者均为早期霍奇金淋巴瘤，在放疗前接受化疗。放疗采用欧洲癌症研究与治疗组织指南中的 INRT 概念。IMRT 是在患者自由呼吸时进行的。对于适应性屏气技术，使用专门用于 DIBH 放疗的肺活量计。对于那些患者，采用三维适形放疗。
2003 年 1 月至 2008 年 8 月期间，50 例霍奇金淋巴瘤患者（48 例初治患者、1 例复发患者和 1 例难治性疾病患者）入组本研究。32 例患者接受 IMRT 治疗，18 例患者接受 DIBH 技术治疗。中位年龄为 28 岁（范围，17-62 岁）。34 例（68%）患者为Ⅰ-ⅡA 期（Ⅰ-IIA）疾病，16 例（32%）患者为Ⅰ-ⅡB 期（Ⅰ-IIB）疾病。除 3 例患者外，其余患者均接受了 3-6 个周期的阿霉素、博来霉素、长春碱和达卡巴嗪（ABVD）化疗。接受 IMRT 和 DIBH 治疗的患者的中位放疗剂量分别为 40 Gy（范围，21.6-40 Gy）和 30.6 Gy（范围，19.8-40 Gy）。各种危及器官的保护均令人满意。中位随访时间为 53.4 个月（范围，19.1-93 个月）。全人群的 5 年无进展生存率和总生存率分别为 92%（95%置信区间 [CI]，80%-97%）和 94%（95% CI，75%-98%）。4 例患者出现复发：2 例患者为肿瘤场内复发，2 例患者为内脏复发。1 例发生 3 级急性肺毒性（短暂性肺炎）。
我们的结果表明，采用 INRT 概念和现代放疗技术（如 IMRT 和 DIBH），可以安全有效地治疗局限性霍奇金淋巴瘤患者。
