Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, 77030, USA.
Am J Clin Oncol. 2011 Oct;34(5):499-505. doi: 10.1097/COC.0b013e3181f477a8.
To examine the role of consolidation radiation therapy (RT) for patients with stage III Hodgkin lymphoma.
We retrospectively reviewed 118 patients with stage III Hodgkin lymphoma who were diagnosed and treated at the University of Texas M.D. Anderson Cancer Center from 1993 through 2006. We evaluated the influence of site and size of initial involvement and use of consolidative RT on survival and patterns of failure after complete response (CR) to ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine).
After chemotherapy, 104 patients (88%) achieved CR; median follow-up time was 68 months (range, 8 to 190). Seventy-one patients (68%) received ≥6 cycles of ABVD, and 40 patients (38.5%) received consolidative RT. Comparing patients who received RT with those who did not, the 5-year, 10-year, and 15-year overall survival (OS) rates were 98%, 80%, and 80% versus 91%, 72%, and 29%, respectively (P=0.08). Disease-free survival (DFS) rates were 94%, 81%, 65% versus 78%, 45%, and 15%, respectively (P=0.04). On multivariate analysis, the presence of initial mediastinal involvement (P=0.001) and bulky head and neck disease (P=0.001) was associated with worse DFS; mediastinal RT was associated with improved DFS (P=0.003) and OS (P=0.029). Use of ≥6 cycles of ABVD was associated with improved OS (P=0.001). The pattern of failure analysis showed that most failures (23 of 28) occurred above the diaphragm.
Consolidative RT after CR may benefit patients with initial disease above the diaphragm, whereas below-the-diaphragm disease seems to be well managed by chemotherapy alone.
探讨巩固性放射治疗（RT）在 III 期霍奇金淋巴瘤患者中的作用。
我们回顾性分析了 1993 年至 2006 年期间在德克萨斯大学 MD 安德森癌症中心诊断和治疗的 118 例 III 期霍奇金淋巴瘤患者。我们评估了初始受累部位和大小以及巩固性 RT 的应用对 ABVD 化疗（多柔比星、博来霉素、长春碱和达卡巴嗪）完全缓解（CR）后生存和失败模式的影响。
化疗后，104 例（88%）患者达到 CR；中位随访时间为 68 个月（范围为 8 至 190 个月）。71 例（68%）患者接受了≥6 个周期的 ABVD，40 例（38.5%）患者接受了巩固性 RT。与接受 RT 的患者相比，未接受 RT 的患者的 5 年、10 年和 15 年总生存率（OS）分别为 98%、80%和 80%比 91%、72%和 29%（P=0.08）。无疾病生存率（DFS）分别为 94%、81%、65%比 78%、45%和 15%（P=0.04）。多因素分析显示，初始纵隔受累（P=0.001）和头颈部大肿块（P=0.001）与较差的 DFS 相关；纵隔 RT 与改善 DFS（P=0.003）和 OS（P=0.029）相关。使用≥6 个周期的 ABVD 与改善 OS 相关（P=0.001）。失败模式分析显示，大多数失败（28 例中的 23 例）发生在膈肌以上。
CR 后巩固性 RT 可能有益于初始膈肌以上疾病患者，而膈肌以下疾病似乎可以单独化疗很好地控制。
