Torok Jordan A, Wu Yuan, Prosnitz Leonard R, Kim Grace J, Beaven Anne W, Diehl Louis F, Kelsey Chris R
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina.
Int J Radiat Oncol Biol Phys. 2015 May 1;92(1):54-9. doi: 10.1016/j.ijrobp.2015.02.003.
The German Hodgkin Study Group (GHSG) trial HD11 established 4 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) and 30 Gy of radiation therapy (RT) as a standard for early stage (I, II), unfavorable Hodgkin lymphoma (HL). Additional cycles of ABVD may allow for a reduction in RT dose and improved toxicity profile.
Patients treated with combined modality therapy at the Duke Cancer Institute for early stage, unfavorable HL by GHSG criteria from 1994 to 2012 were included. Patients who did not undergo post-chemotherapy functional imaging (positron emission tomography or gallium imaging) or who failed to achieve a complete response were excluded. Clinical outcomes were estimated using the Kaplan-Meier method. Late effects were also evaluated.
A total of 90 patients met inclusion criteria for analysis. Median follow-up was 5 years. Chemotherapy consisted primarily of ABVD (88%) with a median number of 6 cycles. The median dose of consolidation RT was 23.4 Gy. Four patients had relapses, 2 of which were in-field. Ten-year progression-free survival (PFS) and overall survival (OS) were 93% (95% confidence interval [CI]: 0.82-0.97) and 98% (95% CI: 0.92-0.99), respectively. For the subset of patients (n=46) who received 5 to 6 cycles of chemotherapy and ≤ 24 Gy, the 10-year PFS and OS values were 88% (95% CI: 70%-96%) and 98% (95% CI: 85% - 99%), respectively. The most common late effect was hypothyroidism (20%) with no cardiac complications. Seven secondary malignancies were diagnosed, with only 1 arising within the RT field.
Lower doses of RT may be sufficient when combined with more than 4 cycles of ABVD for early stage, unfavorable HL and may result in a more favorable toxicity profile than 4 cycles of ABVD and 30 Gy of RT.
德国霍奇金淋巴瘤研究组（GHSG）的HD11试验确定了以4个周期的阿霉素、博来霉素、长春花碱和达卡巴嗪（ABVD）化疗方案及30 Gy放射治疗（RT）作为早期（I、II期）预后不良霍奇金淋巴瘤（HL）的标准治疗方案。额外的ABVD化疗周期可能会使放疗剂量降低，并改善毒性反应。
纳入1994年至2012年在杜克癌症研究所按照GHSG标准接受综合治疗的早期预后不良HL患者。未接受化疗后功能成像（正电子发射断层扫描或镓成像）或未达到完全缓解的患者被排除。采用Kaplan-Meier法评估临床结局。同时也评估了远期效应。
共有90例患者符合分析纳入标准。中位随访时间为5年。化疗主要采用ABVD方案（88%），中位化疗周期数为6个周期。巩固放疗的中位剂量为23.4 Gy。4例患者复发，其中2例为野内复发。10年无进展生存期（PFS）和总生存期（OS）分别为93%（95%置信区间[CI]：0.82 - 0.97）和98%（95% CI：0.92 - 0.99）。对于接受5至6个周期化疗且放疗剂量≤24 Gy的患者亚组（n = 46），10年PFS和OS值分别为88%（95% CI：70% - 96%）和98%（95% CI：85% - 99%）。最常见的远期效应是甲状腺功能减退（20%），无心脏并发症。诊断出7例继发性恶性肿瘤，仅1例发生在放疗野内。
对于早期预后不良HL患者，联合超过4个周期的ABVD化疗时，较低剂量的放疗可能就足够了，并且与4个周期的ABVD化疗及30 Gy放疗相比，可能会带来更有利的毒性反应。
