Lee C K, Bloomfield C D, Goldman A I, Levitt S H
Cancer. 1980 Dec 1;46(11):2403-9. doi: 10.1002/1097-0142(19801201)46:11<2403::aid-cncr2820461116>3.0.co;2-9.
We evaluated the prognostic significance of mediastinal involvement in Hodgkin's disease in 79 consecutive newly diagnosed patients treated with curative-intent, nodal radiotherapy. Mediastinal masses were classified large or small depending on whether the ratio of the largest transverse diameter of the mass to the transverse diameter of the thorax at T5-6 was greater than or equal to 35. Forty-eight patients had mediastinal disease; 20 had large masses, and 28 small masses. Complete remissions were achieved in 19 patients with large masses, 26 with small masses and all patients with no mediastinal masses. Relapse have occurred in 74% of patients with large masses but in only 27% with small masses and 19% without masses (P < .001). This high recurrence rate among patients with large masses could not be explained by other known adverse prognostic factors. Survival was adversely influenced by mediastinal mass size (P = .03). We conclude that curative-intent, nodal irradiation is inadequate therapy for patients with large mediastinal masses. Controlled studies are needed to determine if survival can be improved by the addition of chemotherapy or whole lung irradiation.
我们评估了79例接受根治性意图的淋巴结放疗的新诊断霍奇金病患者纵隔受累的预后意义。根据肿块最大横径与T5 - 6水平胸廓横径之比是否大于或等于35，将纵隔肿块分为大或小。48例患者有纵隔疾病；20例有大肿块，28例有小肿块。19例大肿块患者、26例小肿块患者以及所有无纵隔肿块的患者均实现完全缓解。大肿块患者的复发率为74%，而小肿块患者仅为27%，无肿块患者为19%（P <.001）。大肿块患者的高复发率无法用其他已知的不良预后因素来解释。纵隔肿块大小对生存有不利影响（P =.03）。我们得出结论，对于有大纵隔肿块的患者，根治性意图的淋巴结照射是不充分的治疗方法。需要进行对照研究以确定添加化疗或全肺照射是否能改善生存。
