Henkelmann G C, Hagemeister F B, Fuller L M
Department of Clinical Radiotherapy, University of Texas System Cancer Center, M.D. Anderson Hospital and Tumor Institute, Houston 77030.
J Clin Oncol. 1988 Aug;6(8):1293-302. doi: 10.1200/JCO.1988.6.8.1293.
One hundred two adult patients with stage III1A (76 patients) and stage III1B (26 patients) Hodgkin's disease were treated with two cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) and radiotherapy (XRT) between 1970 and 1984. Sixty-four of the patients were treated between 1970 and 1978 with two cycles of MOPP and XRT to the mantle, upper abdomen, and pelvis. The remaining 38 patients were treated from 1978 to 1984 with a modification of the protocol in which pelvic XRT was omitted and low-dose whole-lung XRT was administered to patients with unfavorable mediastinal disease. The 10-year actuarial freedom-from-progression (FFP) and determinate survival rates at a mean follow-up of 93 months were 84% and 86% for stage III1 disease, 86% and 84% for stage III1A disease, and 78% and 91% for stage III1B disease. Three patients died of treatment-related toxicities without evidence of Hodgkin's disease, two died of complications of myelosuppression and one of acute nonlymphocytic leukemia (ANLL). Neither FFP nor determinate survival rates were significantly influenced by B symptoms, unfavorable mediastinal disease, histologic subtype, extent of abdominal disease, the omission of pelvic XRT, the use of whole-lung XRT, or the number of splenic nodules. Patients 40 years of age or older had a 73% determinate survival rate at 10 years compared with 88% for patients younger than 40 years (P = .01). This survival difference was due to treatment-related toxicity in the older group. This study indicates that two cycles of MOPP and XRT to the mantle and upper abdomen is as effective as more intensive treatment for all patients with stage III1 Hodgkin's disease. This treatment program can preserve fertility and has had only a 1% actuarial incidence of ANLL at 15 years.
1970年至1984年间，102例III1A期（76例）和III1B期（26例）霍奇金病成年患者接受了两个周期的氮芥、长春新碱、丙卡巴肼和泼尼松（MOPP）方案治疗及放射治疗（XRT）。其中64例患者在1970年至1978年间接受了两个周期的MOPP方案治疗，并对斗篷野、上腹部和盆腔进行放射治疗。其余38例患者在1978年至1984年间接受了方案改良治疗，其中盆腔放射治疗被省略，对纵隔情况不佳的患者给予低剂量全肺放射治疗。在平均93个月的随访中，III1期疾病患者的10年无进展生存（FFP）精算率和确定生存率分别为84%和86%，III1A期疾病患者为86%和84%，III1B期疾病患者为78%和91%。3例患者死于与治疗相关的毒性反应，尸检未发现霍奇金病证据，2例死于骨髓抑制并发症，1例死于急性非淋巴细胞白血病（ANLL）。B症状、纵隔情况不佳、组织学亚型、腹部疾病范围、盆腔放射治疗的省略、全肺放射治疗的使用或脾结节数量均未对FFP和确定生存率产生显著影响。40岁及以上患者10年确定生存率为73%，而40岁以下患者为88%（P = 0.01）。这种生存差异是由于老年组与治疗相关的毒性反应所致。本研究表明，对于所有III1期霍奇金病患者，两个周期的MOPP方案及对斗篷野和上腹部的放射治疗与更强化的治疗效果相同。该治疗方案可保留生育能力，15年时ANLL的精算发病率仅为1%。
