Mundt A J, Sibley G, Williams S, Hallahan D, Nautiyal J, Weichselbaum R R
Department of Radiation and Cellular Oncology, Michael Reese/University of Chicago Center for Radiation Therapy, IL 60637, USA.
Int J Radiat Oncol Biol Phys. 1995 Sep 30;33(2):261-70. doi: 10.1016/0360-3016(95)00180-7.
To evaluate the patterns of failure and outcome of patients undergoing high-dose chemotherapy and autologous bone marrow transplantation for relapsed/refractory Hodgkin's disease with emphasis on the impact of involved-field radiotherapy.
Fifty-four adult patients with refractory (25) or relapsed (29) Hodgkin's disease underwent high-dose chemotherapy with either autologous bone marrow (32) or peripheral stem cell (23) transplantation. Twenty patients received involved-field radiotherapy either prior to (7) or following (13) high-dose chemotherapy. Patients treated prior to the high-dose chemotherapy received radiation to bulky or symptomatic sites, and those treated following the transplantation were treated to sites of disease persistence (10) or to consolidate a complete response (3). Twenty-six patients had purely nodal disease, 10 had lung involvement, 7 liver, 5 bone, and 3 bone marrow. A total of 147 sites were present prior to high-dose chemotherapy. Nineteen were bulky (> or = 5 cm), and 42 arose in a previous radiotherapy field.
Twenty-five of the 54 patients (46.3%) relapsed. Seventeen (68.0%) relapsed in sites of disease present prior to high-dose chemotherapy. Patients treated with involved-field radiotherapy had a lower rate of relapse in sites of prior disease involvement (26.3 vs. 42.8%) (p < 0.05) than those not treated with radiotherapy. Twenty-one patients had disease persistence following high-dose chemotherapy, of which 10 received involved-field radiotherapy and were converted to a complete response. Patients with disease persistence who received involved-field radiotherapy had a better progression-free survival (40.0 vs. 12.1%) (p = 0.04) than those who did not. Moreover, the patients converted to a complete response had similar progression-free and cause-specific survival as those patients achieving a complete response with high-dose chemotherapy alone. Of the initial 147 sites, 142 (97.3%) were amenable to involved-field radiation therapy. The addition of involved-field radiotherapy improved the 5-year local control of all sites (p = 0.008), nodal sites (p = 0.01), and sites of disease persistence (p = 0.0009).
Patients with relapsed/refractory Hodgkin's disease undergoing high-dose chemotherapy and autologous bone marrow rescue have a high rate of relapse in sites of prior disease involvement. Involved-field radiotherapy is capable of improving the control of these sites, the majority of which are amenable to radiotherapy. In addition, the use of radiotherapy to sites of disease persistence following high-dose chemotherapy may improve the outcome of these patients.
评估接受大剂量化疗及自体骨髓移植治疗复发/难治性霍奇金淋巴瘤患者的失败模式及预后，重点关注累及野放疗的影响。
54例成年复发（29例）或难治性（25例）霍奇金淋巴瘤患者接受了大剂量化疗，其中32例采用自体骨髓移植，23例采用外周血干细胞移植。20例患者在大剂量化疗之前（7例）或之后（13例）接受了累及野放疗。在大剂量化疗之前接受放疗的患者针对大块或有症状部位进行照射，移植后接受放疗的患者针对疾病持续存在部位（10例）或巩固完全缓解进行照射（3例）。26例患者仅有淋巴结受累，10例有肺部受累，7例有肝脏受累，5例有骨骼受累，3例有骨髓受累。大剂量化疗前共有147个部位存在病变。19个为大块病变（≥5 cm），42个出现在既往放疗野内。
54例患者中有25例（46.3%）复发。17例（68.0%）在大剂量化疗前存在病变的部位复发。接受累及野放疗的患者在既往疾病受累部位的复发率（26.3%对42.8%）（p<0.05）低于未接受放疗的患者。21例患者在大剂量化疗后疾病持续存在，其中10例接受了累及野放疗并转为完全缓解。接受累及野放疗的疾病持续存在患者的无进展生存率（40.0%对12.1%）（p = 0.04）高于未接受放疗的患者。此外，转为完全缓解的患者与仅通过大剂量化疗达到完全缓解的患者具有相似的无进展生存率和病因特异性生存率。在最初的147个部位中，142个（97.3%）适合进行累及野放疗。添加累及野放疗提高了所有部位（p = 0.008）、淋巴结部位（p = 0.01）和疾病持续存在部位（p = 当0.0009）的5年局部控制率。
接受大剂量化疗及自体骨髓挽救治疗的复发/难治性霍奇金淋巴瘤患者在既往疾病受累部位的复发率较高。累及野放疗能够改善这些部位的控制，其中大多数部位适合放疗。此外，在大剂量化疗后对疾病持续存在部位使用放疗可能改善这些患者的预后。
