Department of Radiation Oncology, University of Toronto, Toronto, ON.
Hematology Am Soc Hematol Educ Program. 2011;2011:323-9. doi: 10.1182/asheducation-2011.1.323.
Extended-field and subtotal nodal radiation therapy (RT), developed in the 1960s, was the first reliably curative treatment for early-stage Hodgkin lymphoma (HL). However, the large volume of normal tissue irradiated resulted in significant delayed toxicity, including cardiac disease and second cancers (SCs). The 30-year cumulative incidence of heart disease among adult survivors receiving 40-45 Gy of extended-field or mantle RT is approximately 30%; the incidence of SCs is similar. Improving disease control while reducing the toxicity of treatment has been a major objective of HL trials for more than 2 decades. Contemporary involved-field RT (IFRT) reduces irradiated volumes and produces significant reductions in normal tissue dose compared with historic treatments. Recent data indicate that, compared with mantle RT, IFRT reduces the relative risk of breast cancer among young females receiving mediastinal RT by approximately 60% and also reduces cardiac dose. The recent transition to involved-node RT allows further reductions in normal tissue dose. Response-adapted therapy is being evaluated in clinical trials as a means of identifying those patients most likely to benefit from treatment reduction or intensification, enhanced screening will facilitate early intervention to reduce the clinical burden of late effects, and there is increasing interest in elucidating the genetic correlates of treatment toxicity.
扩展野和次全淋巴结放射治疗（RT）于 20 世纪 60 年代发展起来，是早期霍奇金淋巴瘤（HL）的首次可靠治愈性治疗方法。然而，照射的正常组织体积较大导致了明显的延迟毒性，包括心脏病和第二癌症（SCs）。接受 40-45Gy 扩展野或斗篷 RT 的成年幸存者，30 年内心脏病的累积发病率约为 30%；SCs 的发病率相似。在 20 多年的 HL 试验中，提高疾病控制率同时降低治疗毒性一直是主要目标。当代累及野放射治疗（IFRT）与历史治疗相比，减少了照射体积，降低了正常组织剂量。最近的数据表明，与斗篷 RT 相比，IFRT 使接受纵隔 RT 的年轻女性乳腺癌的相对风险降低了约 60%，同时还降低了心脏剂量。最近向累及淋巴结放射治疗的转变允许进一步降低正常组织剂量。适应反应的治疗正在临床试验中进行评估，作为识别最有可能从治疗减少或强化中获益的患者的一种方法，强化筛查将有助于早期干预，以减轻晚期效应的临床负担，并且越来越关注阐明治疗毒性的遗传相关性。
