晚期霍奇金淋巴瘤采用联合治疗后的预后因素和失败模式。
Prognostic factors and patterns of failure in advanced stage Hodgkin lymphoma treated with combined modality therapy.
机构信息
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, USA.
Department of Medicine, Stanford University School of Medicine, Stanford, USA.
出版信息
Radiother Oncol. 2018 Dec;129(3):507-512. doi: 10.1016/j.radonc.2018.06.033. Epub 2018 Jul 6.
BACKGROUND AND PURPOSE
The role of irradiation to non-bulky and bulky sites of disease in advanced stage Hodgkin lymphoma is controversial. We aimed to review the long-term outcomes of patients treated with combined modality therapy to clarify the role of consolidative radiotherapy.
MATERIALS AND METHODS
Patients with stage III or IV Hodgkin lymphoma treated with Stanford V chemotherapy and consolidative radiotherapy to initial sites of disease ≥5 cm were analyzed retrospectively to determine patient outcomes, patterns of failure, and factors associated with treatment failure.
RESULTS
A total of 170 patients were analyzed. Overall survival was 91.2%, freedom from progression was 80.6%, and progression-free survival was 78.9% at 10 years. 5 patients (2.9%) had refractory disease and 27 patients (15.9%) relapsed after treatment. Only an International Prognostic Score (IPS) greater than 2 predicted disease progression. 19 out of 27 relapses occurred exclusively outside of the radiation treatment field, and 17 out of 27 relapses occurred exclusively at original sites of disease. However, only 11 of 170 patients (6.5%) relapsed exclusively at original, non-bulky sites of disease not treated with radiation therapy. The cumulative incidence of local failure at 10 years was 4.6% for unirradiated sites and 2.6% for irradiated sites.
CONCLUSION
Patients with advanced stage Hodgkin lymphoma treated with combined modality therapy including consolidative radiotherapy to bulky disease sites had excellent long-term outcomes. Given the low frequency of isolated failures at initial sites, our results suggest that selective radiation therapy to sites at high risk of relapse may be feasible.
背景与目的
对于晚期霍奇金淋巴瘤（HL）非肿块和肿块部位的照射作用存在争议。我们旨在通过回顾性分析接受联合治疗的患者的长期结果，以明确巩固性放疗的作用。
材料与方法
回顾性分析了接受斯坦福 V 化疗和对初始疾病部位（≥5cm）进行巩固性放疗的 III 期或 IV 期 HL 患者，以确定患者的结局、失败模式以及与治疗失败相关的因素。
结果
共分析了 170 例患者。10 年时总生存率为 91.2%，无进展生存率为 80.6%，无进展生存为 78.9%。5 例（2.9%）患者疾病难治，27 例（15.9%）患者治疗后复发。仅国际预后评分（IPS）＞2 预测疾病进展。27 例复发中，仅 19 例（70.4%）复发完全位于放疗野外，17 例（63.0%）仅位于初始疾病部位。然而，170 例患者中仅 11 例（6.5%）仅在未经放疗的初始非肿块部位复发。10 年时未放疗部位的局部失败累积发生率为 4.6%，放疗部位为 2.6%。
结论
接受包括对肿块部位进行巩固性放疗的联合治疗的晚期 HL 患者具有良好的长期结局。鉴于初始部位孤立复发的频率较低，我们的结果表明，对高复发风险部位进行选择性放疗可能是可行的。
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