Bartlett N L, Rosenberg S A, Hoppe R T, Hancock S L, Horning S J
Department of Medicine, Stanford University School of Medicine, CA, USA.
J Clin Oncol. 1995 May;13(5):1080-8. doi: 10.1200/JCO.1995.13.5.1080.
Although survival rates have improved for patients with bulky and advanced-stage Hodgkin's disease (HD), current treatments entail substantial acute morbidity and risks for late effects such as infertility, second malignancies, and cardiopulmonary toxicities. A novel, brief chemotherapy regimen (doxorubicin, vinblastine, mechlorethamine, vincristine, bleomycin, etoposide, and prednisone [Stanford V]) was designed to shorten the duration of treatment, significantly reduce cumulative doses of alkylating agents, doxorubicin, and bleomycin, and maintain dose-intensity (DI). This brief chemotherapy was combined with radiation therapy (RT) to bulky disease sites.
Since May 1989, 65 previously untreated patients were treated for stage II HD with bulky mediastinal involvement (n = 21) or for stage III or IV HD (n = 44). Patients received weekly chemotherapy for 12 weeks. Consolidative RT was given to the first 25 patients to sites of initial bulky disease or radiographic abnormalities that persisted after chemotherapy; in the remaining 40 patients, RT was limited to bulky disease (adenopathy > or = 5 cm and/or macroscopic splenic nodules defined by computed tomography [CT]).
With a median follow-up period of 2 years, actuarial 3-year survival rate is 96% and failure-free survival (FFS) rate is 87%. The 3-year FFS rate is 100% for stage II patients with bulky mediastinal disease and 82% for patients with stage III to IV disease. There were no treatment-related deaths. In a preliminary analysis on a subset of patients, female and male fertility appears to be preserved.
These preliminary results indicate that the Stanford V chemotherapy regimen with or without RT is well-tolerated and effective therapy for bulky, limited-stage, and advanced-stage HD. Less cumulative exposure to alkylating agents, doxorubicin, and bleomycin and limited use of radiation is expected to decrease risks for second neoplasms and late cardiopulmonary toxicity. Based on these results, the Stanford V chemotherapy with or without RT regimen deserves further study in the context of a randomized clinical trial.
尽管晚期霍奇金淋巴瘤（HD）患者的生存率有所提高，但目前的治疗方法会带来严重的急性发病率以及诸如不孕、二次肿瘤和心肺毒性等晚期效应的风险。一种新型的短期化疗方案（多柔比星、长春碱、氮芥、长春新碱、博来霉素、依托泊苷和泼尼松[斯坦福V方案]）旨在缩短治疗时间，显著降低烷化剂、多柔比星和博来霉素的累积剂量，并维持剂量强度（DI）。这种短期化疗与针对大块病灶部位的放射治疗（RT）相结合。
自1989年5月起，65例既往未接受过治疗的患者接受了治疗，其中21例为伴有大块纵隔受累的II期HD患者，44例为III期或IV期HD患者。患者接受为期12周的每周一次化疗。对前25例患者针对初始大块病灶部位或化疗后仍存在的影像学异常部位进行巩固性RT；在其余40例患者中，RT仅限于大块病灶（肿大淋巴结≥5 cm和/或由计算机断层扫描[CT]定义的脾脏宏观结节）。
中位随访期为2年，3年精算生存率为96%，无病生存率（FFS）为87%。伴有大块纵隔疾病的II期患者3年FFS率为100%，III至IV期患者为82%。无治疗相关死亡。在对部分患者的初步分析中，女性和男性的生育能力似乎得以保留。
这些初步结果表明，无论有无RT，斯坦福V化疗方案对于大块、局限期和晚期HD都是耐受性良好且有效的治疗方法。烷化剂、多柔比星和博来霉素的累积暴露减少以及放射治疗的有限使用有望降低二次肿瘤和晚期心肺毒性的风险。基于这些结果，无论有无RT的斯坦福V化疗方案值得在随机临床试验的背景下进一步研究。
