Salvagno L, Sorarù M, Sotti G, Aversa S, Chiarion Sileni V, Mazzarotto R, Scarzello G, Bianco A, Pappagallo G L, Fiorentino M V
Division of Medical Oncology, Centro Oncologico Regionale, Padova, Italy.
Ann Oncol. 1995 Feb;6(2):173-9. doi: 10.1093/oxfordjournals.annonc.a059113.
In patients with advanced Hodgkin's disease (HD), the alternation of MOPP with ABVD or hybrid MOPP/ABVD are associated with a high CR rate and a high probability of 5-year survival. However, even after effective chemotherapy the risk of nodal relapse is not negligible, and not only in initial bulky site(s) of disease. For this reason, in an attempt to prevent relapses after combination chemotherapy alone, we performed a prospective study to evaluate the efficacy and toxic effects of 6 courses of hybrid MOPP/ABVD followed by radiotherapy (RT) in stages II A bulky, II B, III and also in stage IV with bulky disease of residual after chemotherapy.
From January 1985 to August 1993, 133 patients with HD (128 newly diagnosed, stage II A bulky-IV, 5 in first relapse after RT) were treated according to the following program: 6 courses of the hybrid MOPP/ABVD regimen followed by RT (STNI + spleen in stages II A, II B, III without pelvic lymph node involvement, TNI + spleen in stage III with pelvic lymph node involvement, involved field in stage IV with bulky disease or residual after chemotherapy). The total dose of RT was 4000 cGy to the sites of bulky or residual disease and 2000 cGy to the other sites.
After hybrid MOPP/ABVD, 107 of 130 (82.3%) fully evaluable patients were classified as in CR or CR(U). After completion of RT, 108 patients were in CR and 3 were in PR, for an overall response rate of 85%. With a median follow-up duration of 45 months, the actuarial 5-year survival is 76% and the progression-free survival 68.6%. So far, only 14 patients have relapsed (6 within the irradiation field) and the 5-year relapse-free survival is 82.5%.
Six courses of hybrid MOPP/ABVD followed by RT in stages II A bulky, II B, III and in stage IV with bulky disease or residual after chemotherapy produced a high CR rate with low risk of relapse. However, a longer follow-up is necessary to evaluate the late effects of combined therapy.
在晚期霍奇金淋巴瘤（HD）患者中，MOPP方案与ABVD方案交替使用或采用混合MOPP/ABVD方案，其完全缓解（CR）率高，5年生存率也高。然而，即使经过有效的化疗，淋巴结复发风险仍不可忽视，且不仅局限于疾病的初始大包块部位。因此，为了尝试预防单纯联合化疗后的复发，我们进行了一项前瞻性研究，以评估6个疗程的混合MOPP/ABVD方案后行放疗（RT），对于II A期大包块、II B期、III期以及化疗后有大包块残留的IV期HD患者的疗效和毒性作用。
从1985年1月至1993年8月，133例HD患者（128例初诊，II A期大包块-IV期，5例放疗后首次复发）按以下方案治疗：6个疗程的混合MOPP/ABVD方案后行放疗（II A期、II B期、无盆腔淋巴结受累的III期患者行受累野放疗（STNI）+脾脏放疗，有盆腔淋巴结受累的III期患者行全淋巴结照射（TNI）+脾脏放疗，化疗后有大包块或残留的IV期患者行受累野放疗）。放疗总剂量为，大包块或残留病灶部位4000 cGy，其他部位2000 cGy。
混合MOPP/ABVD方案治疗后，130例可全面评估的患者中有107例（82.3%）被归类为CR或CR（U）。放疗结束后，108例患者达到CR，3例患者达到PR，总缓解率为85%。中位随访时间为45个月，精算5年生存率为76%，无进展生存率为68.6%。到目前为止，仅14例患者复发（6例在照射野内），5年无复发生存率为82.5%。
对于II A期大包块、II B期、III期以及化疗后有大包块或残留的IV期HD患者，6个疗程的混合MOPP/ABVD方案后行放疗可产生高CR率且复发风险低。然而，需要更长时间的随访来评估联合治疗的晚期效应。
