Dowling S W, Peschel R E, Portlock C S, Kramer C, Farber L R, Knowlton A H
Dept. of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06510.
Int J Radiat Oncol Biol Phys. 1990 Sep;19(3):543-6. doi: 10.1016/0360-3016(90)90479-4.
Patients with Hodgkin's disease who present with large mediastinal masses in the setting of either early or advanced stage disease are frequently treated with combined modality therapy. Policies for radiation dose to the mediastinum in these settings range from no radiation to doses in the 3600-4000 cGy range. We reviewed the charts of 50 patients treated with radiation therapy following remission induction with chemotherapy between 1979 and 1983 to determine whether the dose of radiation to the mediastinum could be correlated with mediastinal control, relapse-free, and overall survival. Patients were divided into groups with small (SM, 30 pts.) and large (LM, 20 pts.) mediastinal masses and analyzed according to whether they had received low dose (LD, less than or equal to 2500 cGy) or high dose (HD, greater than 2500 cGy) radiation to the mediastinum. The 5-year relapse-free survival (RFS) for all 50 patients was 84% (+/- 8%, 95% confidence limits). For the patients with small mediastinal masses, 5-year RFS was 81% +/- 20%, and for the patients with large mediastinal masses, 89% +/- 16%. No clear dose-response effect was observed when the outcomes of the low dose and high dose patients were compared. This was true even in the patients with large mediastinal masses although the high dose subset of this group included patients felt to be at a higher risk for relapse following chemotherapy. Nine of eleven patients with large mediastinal masses treated with chemotherapy and low dose radiation remain disease-free. There was only one isolated mediastinal relapse in the entire group of patients. Treatment was well tolerated with no acute treatment-related deaths. Two patients developed second malignancies. We conclude that combined modality therapy using low dose radiation results in excellent 5-year relapse-free survival for most small and many large mediastinal mass patients, and that it is not necessary to treat all chemotherapy patients who present with mediastinal disease with high dose radiation to achieve these relapse-free survival rates.
患有霍奇金病且在疾病早期或晚期出现大纵隔肿块的患者通常采用综合治疗。在这些情况下，纵隔放射剂量的策略范围从不进行放射到3600 - 4000 cGy的剂量。我们回顾了1979年至1983年间50例化疗诱导缓解后接受放射治疗患者的病历，以确定纵隔放射剂量是否与纵隔控制、无复发生存率和总生存率相关。患者被分为纵隔肿块小（SM，30例）和大（LM，20例）的两组，并根据他们是否接受了低剂量（LD，小于或等于2500 cGy）或高剂量（HD，大于2500 cGy）的纵隔放射进行分析。所有50例患者的5年无复发生存率（RFS）为84%（±8%，95%置信区间）。纵隔肿块小的患者5年RFS为81%±20%，纵隔肿块大的患者为89%±16%。比较低剂量和高剂量患者的结果时，未观察到明显的剂量反应效应。即使在纵隔肿块大的患者中也是如此，尽管该组高剂量亚组包括被认为化疗后复发风险较高的患者。11例接受化疗和低剂量放射治疗的纵隔肿块大的患者中有9例仍无疾病。整个患者组中仅有1例孤立的纵隔复发。治疗耐受性良好，无急性治疗相关死亡。2例患者发生了第二原发性恶性肿瘤。我们得出结论，对于大多数纵隔肿块小和许多纵隔肿块大的患者，采用低剂量放射的综合治疗可实现出色的5年无复发生存率，并且对于所有出现纵隔疾病的化疗患者，无需用高剂量放射治疗来达到这些无复发生存率。
