Roncadin M, Arcicasa M, Zagonel V, Bortolus R, Valeri P, Pinto A, De Paoli A, Franchin G, Carbone A, Trovò M G
Radiotherapy Division, Centro di Riferimento Oncologico, Aviano, Italy.
Cancer. 1994 Aug 1;74(3):978-84. doi: 10.1002/1097-0142(19940801)74:3<978::aid-cncr2820740330>3.0.co;2-b.
The efficacy and toxicity of total body irradiation (TBI) in patients with chronic lymphocytic leukemia (CLL) and low grade non-Hodgkin's lymphomas (NHL) were evaluated.
Between January 1984 and September 1992, 81 consecutive patients, 40 affected with CLL and 41 with low grade NHL, with symptomatic Stage III and IV disease, were treated with TBI followed by prednimustine. TBI was given with a 6 MV linear accelerator, applying two opposite alternating fields, including total body, with two fractions of 15 cGy given per week (3-day interval). A total dose of 150 cGy was given over 5 weeks. Six to nine courses of prednimustine (100 mg/m2 orally for 5 consecutive days every 4 weeks) was administered 2 months after TBI treatment as consolidation therapy.
Of 40 patients with CLL, 18 (Group I; median age 58.5 years) were younger than 65 years and 22 (Group II; median age 73 years) were older. The overall response rates were 78% in Group I and 91% in Group II, with a median response time of 16.5 and 16 months, respectively. Hematologic toxicity was 72% in Group I and 73% in Group II. It was reversible in all but one heavily pretreated patient who died of progressive anemia and thrombocytopenia after TBI alone. In the 40 patients with CLL, the response rate was 85%; there were 5 complete responses (CRs) (12.5%) and 29 partial responses (PRs) (72.5%). Of the 41 patients with NHL, 29 (Group I; median age 55 years) were younger than 65 years and 12 (Group II; median age 71.5) were older. The overall response rate in both groups was 83%, with median response times of 18.5+ and 14.5+ months for Groups I and II, respectively. Hematologic toxicity was 59% in Group I, whereas it was 50% in Group II. It was reversible in all patients. Overall, in the 41 patients with symptomatic Stage III and IV low grade NHL, the response rate was 82.8%; there were 10 CRs (24.3%) and 24 PRs (58.5%). The prednimustine regimen was generally well tolerated.
In our experience, TBI given in a dose of 150 cGy in 10 fractions twice a week, followed by prednimustine, is an effective treatment for patients with CLL and patients with low grade NHL. This treatment also is effective in patients older than 65 years. The toxicity is acceptable, particularly when TBI and prednimustine are given as initial treatment. Pretreated patients should be monitored strictly.
评估了全身照射（TBI）对慢性淋巴细胞白血病（CLL）和低度非霍奇金淋巴瘤（NHL）患者的疗效及毒性。
1984年1月至1992年9月期间，81例连续患者，40例CLL患者和41例低度NHL患者，有症状的Ⅲ期和Ⅳ期疾病，接受TBI后给予泼尼松氮芥治疗。使用6兆伏直线加速器进行TBI，采用两个相对的交替野，包括全身，每周给予两剂15厘戈瑞（间隔3天）。5周内给予总剂量150厘戈瑞。TBI治疗2个月后给予6至9疗程的泼尼松氮芥（每4周口服100毫克/平方米，连续5天）作为巩固治疗。
40例CLL患者中，18例（I组；中位年龄58.5岁）年龄小于65岁，22例（II组；中位年龄73岁）年龄较大。I组的总缓解率为78%，II组为91%，中位缓解时间分别为16.5个月和16个月。I组血液学毒性为72%，II组为73%。除1例预处理严重的患者在仅接受TBI后死于进行性贫血和血小板减少症外，其余均可逆。在40例CLL患者中，缓解率为85%；有5例完全缓解（CR）（12.5%）和29例部分缓解（PR）（72.5%）。41例NHL患者中，29例（I组；中位年龄55岁）年龄小于65岁，12例（II组；中位年龄71.5岁）年龄较大。两组的总缓解率均为83%，I组和II组的中位缓解时间分别为18.5 +个月和14.5 +个月。I组血液学毒性为59%，II组为50%。所有患者均可逆。总体而言，在41例有症状的Ⅲ期和Ⅳ期低度NHL患者中，缓解率为82.8%；有10例CR（24.3%）和24例PR（58.5%）。泼尼松氮芥方案总体耐受性良好。
根据我们的经验，每周两次给予10次分割、总剂量150厘戈瑞的TBI，随后给予泼尼松氮芥，是治疗CLL患者和低度NHL患者的有效方法。该治疗方法对65岁以上患者也有效。毒性是可接受的，尤其是当TBI和泼尼松氮芥作为初始治疗时。预处理患者应严格监测。
