Rahemtulla Amin, Terpos Evangelos
Faculty of Medicine, Imperial College, London, UK.
BMJ Clin Evid. 2009 Jun 15;2009:2404.
People with Hodgkin's lymphoma usually present with a lump in the neck or upper chest, but a quarter of people also have fever, sweating, weight loss, fatigue, and itch. Almost all people with localised disease can be cured, and, even among people with relapsed advanced disease, almost 80% survive event free for 4 years or more.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: single-regimen chemotherapy treatments; combined chemotherapy and radiotherapy treatments compared with radiotherapy alone; and combined chemotherapy and radiotherapy treatments compared with the same chemotherapy agent alone, for first presentation stage I or II non-bulky disease? What are the effects of: specific combined chemotherapy and radiotherapy treatments versus each other; or different radiotherapy treatment strategies in stage I or II non-bulky disease? What are the effects of: single-regimen chemotherapy treatments; dose-intensified chemotherapy treatments; or combined chemotherapy plus radiotherapy treatments compared with chemotherapy alone, for first presentation stage II (bulky) disease, III, or IV disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2008 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 40 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: ABVD (with or without radiotherapy); ABVPP plus radiotherapy; ChlVPP-EVA; COPP-ABVD plus radiotherapy; CVPP plus radiotherapy; EBVP plus radiotherapy; escalating-dose BEACOPP; extended-field radiotherapy; increased-dose regimens; involved-field radiotherapy; MOPP (with or without radiotherapy); MOPP-ABV plus radiotherapy; and VBM plus radiotherapy.
霍奇金淋巴瘤患者通常表现为颈部或上胸部出现肿块，但四分之一的患者还伴有发热、盗汗、体重减轻、疲劳和瘙痒症状。几乎所有局限性疾病患者都可治愈，即使是复发的晚期疾病患者，近80%也能无事件生存4年或更长时间。
我们进行了一项系统综述，旨在回答以下临床问题：对于初诊为I期或II期非大包块疾病，单药化疗治疗、化疗与放疗联合治疗与单纯放疗相比、化疗与放疗联合治疗与单纯使用相同化疗药物相比，效果如何？对于I期或II期非大包块疾病，特定的化疗与放疗联合治疗相互之间、不同的放疗治疗策略相比，效果如何？对于初诊为II期（大包块）疾病、III期或IV期疾病，单药化疗治疗、剂量强化化疗治疗、化疗加放疗联合治疗与单纯化疗相比，效果如何？我们检索了截至2008年9月的Medline、Embase、Cochrane图书馆及其他重要数据库（临床证据综述会定期更新；请查看我们的网站获取本综述的最新版本）。我们纳入了美国食品药品监督管理局（FDA）和英国药品与保健品监管局（MHRA）等相关组织发布的危害警示。
我们发现40项系统综述、随机对照试验或观察性研究符合我们的纳入标准。我们对干预措施的证据质量进行了GRADE评估。
在本系统综述中，我们呈现了以下干预措施的有效性和安全性相关信息：ABVD（联合或不联合放疗）；ABVPP加放疗；ChlVPP-EVA；COPP-ABVD加放疗；CVPP加放疗；EBVP加放疗；递增剂量BEACOPP；扩大野放疗；增加剂量方案；受累野放疗；MOPP（联合或不联合放疗）；MOPP-ABV加放疗；以及VBM加放疗。
