Murphy S B, Hustu H O
Cancer. 1980 Feb 15;45(4):630-7. doi: 10.1002/1097-0142(19800215)45:4<630::aid-cncr2820450403>3.0.co;2-5.
From 1975 to 1978, 69 children with non-Hodgkin's lymphoma were staged and treated in a randomized protocol to determine the contribution of involved-field radiotherapy (IF-RT) to an effective drug regimen in Stages III-IV and the efficacy of prophylactic treatment of the central nervous system with cranial irradiation and intrathecal methotrexate in Stage II-IV. Induction therapy for Stages I-II was vincristine, prednisone, cyclophosphamide and IF-RT (3000-3500 rad). Stages III-IV received the same three drugs plus adriamycin, and were randomized to received or not receive IF-RT. The complete remission rate was 88%. After randomization to receive CNS prophylaxis or not, all children received oral mercaptopurine and methotrexate for 18 months. The two-year actuarial estimate of disease-free survival for all responders is 55% and is significantly influenced by stage. (Ninety percent disease-free survival for Stages I-II, versus 38.8% for III-IV, P less than .05). We observed no benefit but added toxicity from IF-RT in Stages III-IV. Efforts at CNS prophylaxis in high-risk children are warranted, since only 1 of 18 children randomized to receive prophylaxis developed CNS disease as the site of first relapse, whereas 4 of 16 receiving no prophylaxis did so.
1975年至1978年，69例非霍奇金淋巴瘤患儿按照随机方案进行分期和治疗，以确定受累野放疗（IF-RT）对III-IV期有效药物方案的贡献，以及II-IV期采用颅脑照射和鞘内注射甲氨蝶呤预防性治疗中枢神经系统的疗效。I-II期的诱导治疗为长春新碱、泼尼松、环磷酰胺和IF-RT（3000-3500拉德）。III-IV期接受相同的三种药物加阿霉素治疗，并随机分为接受或不接受IF-RT。完全缓解率为88%。在随机分组接受或不接受中枢神经系统预防性治疗后，所有患儿均接受口服巯嘌呤和甲氨蝶呤治疗18个月。所有缓解者两年无病生存率的精算估计为55%，且受分期的显著影响。（I-II期无病生存率为90%，III-IV期为38.8%，P<0.05）。我们观察到III-IV期IF-RT没有益处，但有额外的毒性。对高危儿童进行中枢神经系统预防性治疗是有必要的，因为随机接受预防性治疗的18名儿童中只有1名发生中枢神经系统疾病作为首次复发部位，而未接受预防性治疗的16名儿童中有4名发生了这种情况。
