Behar R A, Hoppe R T
Department of Radiation Oncology, Stanford University Medical Center, CA 94305.
Cancer. 1990 Jul 1;66(1):75-9. doi: 10.1002/1097-0142(19900701)66:1<75::aid-cncr2820660115>3.0.co;2-z.
From July 1981 to July 1985, 20 patients with bulky mediastinal Hodgkin's Disease (maximum mediastinal width divided by the maximum intrathoracic diameter for a mediastinal mass ratio (MMR) greater than 0.33 were treated at Stanford University with definitive radiation therapy alone. The majority of these patients were selected to receive radiation therapy because they had the more favorable characteristics of minimal extralymphatic involvement, mediastinal masses that were superior and central in location, and a MMR less than or equal to 0.50. All 20 patients were laparotomy staged, and 17 received some radiation to the mantle before laparotomy. Seventeen patients had pathologic stage (PS) II disease (13 PS IIA, 4 PS IIB), two had PS IIISA, and one had PS IB. Eleven patients (55%) had extralymphatic involvement. All patients were irradiated to the mantle field using a shrinking field technique (mediastinal dose, 4400 to 5500 cGy, mean 4990 cGy). After completion of the mantle, all patients with good clinical responses received infradiaphragmatic radiation. Treatment complications included two cases of mild radiation pneumonitis, five of hypothyroidism, five of localized Herpes zoster, one of amenorrhea, one of non-Hodgkin's lymphoma, and one of sepsis. Four patients relapsed. All had an intrathoracic component to their failure. All four patients were salvaged with MOP(P) chemotherapy and are currently alive and free of disease. For the entire group, the actuarial freedom from relapse is 80% at 7 years and the survival is 100%. Median follow-up time is 67 months. The authors conclude that radiation therapy alone is effective in the management of selected patients with Hodgkin's disease who have extensive mediastinal involvement, even when the MMR exceeds 1/3.
1981年7月至1985年7月，斯坦福大学对20例患有巨大纵隔霍奇金病（最大纵隔宽度除以纵隔肿块的最大胸腔内径，纵隔肿块比率（MMR）大于0.33）的患者仅采用确定性放射治疗。这些患者中的大多数被选择接受放射治疗，是因为他们具有以下更有利的特征：极少的结外侵犯、位于上纵隔且中央的纵隔肿块以及MMR小于或等于0.50。所有20例患者均接受了剖腹探查分期，17例在剖腹探查前接受了部分斗篷野照射。17例患者为病理分期（PS）II期疾病（13例PS IIA，4例PS IIB），2例为PS IIISA，1例为PS IB。11例患者（55%）有结外侵犯。所有患者均采用缩野技术对斗篷野进行照射（纵隔剂量为4400至5500 cGy，平均4990 cGy）。斗篷野照射完成后，所有临床反应良好的患者均接受膈下照射。治疗并发症包括2例轻度放射性肺炎、5例甲状腺功能减退、5例局部带状疱疹、1例闭经、1例非霍奇金淋巴瘤和1例败血症。4例患者复发。所有患者的复发均有胸腔内成分。所有4例患者均通过MOP(P)化疗挽救，目前均存活且无疾病。对于整个组，7年时无复发生存率为80%，生存率为100%。中位随访时间为67个月。作者得出结论，即使MMR超过1/3，单纯放射治疗对于治疗选定的有广泛纵隔侵犯的霍奇金病患者也是有效的。
