Tubiana M, Henry-Amar M, Hayat M, Burgers M, Qasim M, Somers R, Sizoo W, van der Schueren E
Int J Radiat Oncol Biol Phys. 1984 Feb;10(2):197-210. doi: 10.1016/0360-3016(84)90004-x.
Since 1964, the European Organisation for Research and Treatment of Cancer has conducted three subsequent clinical trials on clinical Stages (CS) I + II Hodgkin's disease (HD) in which 1059 patients have been entered. The first trial compared regional radiotherapy (RT) with mantle field or inverted Y, versus the same RT followed by a weekly injection of vinblastine for 2 years. The relapse free survival (RFS) and overall survival (S) were higher in patients treated by RT and chemotherapy (CT). This benefit, however, was significant only in patients with a mixed cellularity histologic type. The second trial compared the therapeutic efficacy of splenic irradiation versus splenectomy and found that in both arms, RFS and S were identical. Moreover, it was found that splenic involvement was correlated with an increased incidence of relapse in extranodal sites and in non irradiated lymphatic areas. In this trial, CT was given only to patients with poor histologic types, mixed cellularity or lymphocytic depletion. In the third trial, staging laparotomy was performed only to further delineate a good prognostic group which could be treated by RT alone. In this limited treatment group, there was no difference in RFS and S between mantle field and mantle field + para-aortic RT. In the extensive treatment group, total nodal irradiation (TNI) was compared with RT + MOPP. The RFS was slightly lower in the TNI arm, but there was no significant difference in S. The data of the 3 trials underline the importance of prognostic factors in the choice of optimal treatment and show that their significance depends upon the type of treatment. Multivariate statistical analyses showed that the main prognostic factors, which can help to identify the subsets of patients who can be treated by RT alone, are (1) systemic symptoms and elevated erythrocyte sedimentation rate (ESR), (2) the number of involved lymphatic areas, and (3) staging laparotomy. Extended RT (mantle + para-aortic + spleen treatment) gives satisfactory results in patients without systemic symptoms and/or elevated ESR and one or two involved sites, whereas TNI or combined modality treatment becomes mandatory for patients with 3 or more involved sites or splenic involvement and/or systemic symptoms. With proper adjustment of the irradiated volume, a very large proportion of CS I + II patients can be best treated by RT alone.
自1964年以来，欧洲癌症研究与治疗组织先后开展了三项关于临床分期（CS）I + II期霍奇金淋巴瘤（HD）的临床试验，共有1059例患者入组。第一项试验比较了区域放疗（RT）与斗篷野或倒Y野放疗，以及相同放疗后每周注射长春花碱两年的疗效。接受放疗和化疗（CT）的患者无复发生存期（RFS）和总生存期（S）更高。然而，这种益处仅在混合细胞型组织学类型的患者中显著。第二项试验比较了脾区放疗与脾切除术的治疗效果，发现两组的RFS和S相同。此外，还发现脾受累与结外部位和未照射淋巴区域复发率增加相关。在该试验中，仅对组织学类型差、混合细胞型或淋巴细胞消减型的患者给予CT治疗。在第三项试验中，仅对部分患者进行分期剖腹探查以进一步明确一个可仅接受放疗的良好预后组。在这个有限治疗组中，斗篷野放疗与斗篷野 + 腹主动脉旁放疗的RFS和S无差异。在广泛治疗组中，比较了全淋巴结照射（TNI）与放疗 + MOPP的疗效。TNI组的RFS略低，但S无显著差异。这三项试验的数据强调了预后因素在选择最佳治疗中的重要性，并表明其意义取决于治疗类型。多变量统计分析表明，有助于识别可仅接受放疗的患者亚组的主要预后因素为：（1）全身症状和红细胞沉降率（ESR）升高；（2）受累淋巴区域数量；（3）分期剖腹探查。对于无全身症状和/或ESR升高且有一或两个受累部位的患者，扩大放疗（斗篷野 + 腹主动脉旁 + 脾区治疗）可取得满意效果，而对于有3个或更多受累部位或脾受累和/或全身症状的患者，TNI或综合治疗则是必要的。通过适当调整照射体积，很大一部分CS I + II期患者可仅通过放疗获得最佳治疗效果。
