Fuller L M, Hagemeister F B
Cancer. 1983 Jun 15;51(12 Suppl):2469-76. doi: 10.1002/1097-0142(19830615)51:12+<2469::aid-cncr2820511315>3.0.co;2-4.
Appropriate management of Hodgkin's disease is based on both the stage of disease and the specific anatomic sites of involvement within each stage. As a result of the combination of sequential staging and effective treatment, histopathologic subclassification has become less important. Although not generally appreciated, this is also true for constitutional symptoms. During the past 15 years, differences in survival between early and advanced stages have diminished progressively with refinements both in management of newly diagnosed patients, and in management of relapsing disease. Currently, our five-year survival figure for laparotomy-Staged I and II patients is 95%. The corresponding result for Stages IIIA and IIIB patients is 85%; and 67% of our Stage IV patients, who were treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) are projected to be surviving at five years. With the anticipation of a high probability for cure, quality of life including the possibility for parenthood has become increasingly important. In the past, the trend has been to increase treatment for patients with poor prognostic factors. However, very little attention has been paid to the possibility of administering less treatment for very precisely staged patients with good prognostic factors. In this review, management is discussed by stage. Emphasis is placed on the indications for less treatment as well as for more intensive therapy in adult patients with Hodgkin's disease.
霍奇金淋巴瘤的恰当管理基于疾病分期以及各分期内受累的具体解剖部位。由于序贯分期和有效治疗相结合，组织病理学亚分类已变得不那么重要。尽管通常未得到重视，但全身症状方面也是如此。在过去15年中，随着新诊断患者管理和复发性疾病管理的改进，早期和晚期患者的生存率差异逐渐缩小。目前，我们对经剖腹分期的Ⅰ期和Ⅱ期患者的五年生存率为95%。ⅢA期和ⅢB期患者的相应结果为85%；我们接受氮芥、长春新碱、丙卡巴肼和泼尼松（MOPP）治疗的Ⅳ期患者预计五年生存率为67%。鉴于治愈的可能性很大，包括生育可能性在内的生活质量变得越来越重要。过去的趋势是增加对预后不良因素患者的治疗。然而，对于分期非常精确且预后良好因素的患者给予较少治疗的可能性却很少受到关注。在本综述中，按分期讨论管理方法。重点在于成人霍奇金淋巴瘤患者较少治疗以及更强化治疗的适应证。
