Salloum E, Doria R, Farber L R, Roberts K B, Cooper D L
Yale University School of Medicine, Yale Cancer Center, New Haven, Connecticut 06520, USA.
Cancer J Sci Am. 1995 Nov-Dec;1(4):267-73.
To describe the long-term results of treatment with chemotherapy plus adjuvant low-dose, involved-field radiation therapy (CMT) in patients with advanced Hodgkin's disease. Data on disease-free and failure-free survival, second malignancies, and the results of salvage therapy are presented.
From 1969 to 1989, CMT was administered to 186 patients with previously untreated stage IIB, III, and IV Hodgkin's disease. Chemotherapy included MVVPP (47%), MOPP (25%), MOPP/ABVD (26%) and ABVD (2%). After 6 months of chemotherapy, patients received radiation to all involved sites with the exception of the bone marrow.
The failure-free survival for all patients was 63% at 5 years, 56% at 10 years, and 40% at 23.5 years, respectively. Significantly worse results were observed in patients older than 40 years and those with stage IV disease. The overall survival of 45 patients after recurrence was 39% at 10 years, but was only 21% if the initial complete remission lasted less than 1 year. Thus far, 21 of 165 patients (12.7%) who achieved complete remission have developed a second malignancy, and 16 have died.
In comparison with comparable chemotherapy programs, chemotherapy plus radiation therapy may improve disease-free survival; however, the results of treatment in patients older than age 40 or with stage IV disease are still poor. Although patients with initial remissions lasting longer than 1 year can have durable second remissions, the long-term disease-free survival is poor and in the current series the majority of failures were due to recurrent Hodgkin's disease.
描述晚期霍奇金病患者采用化疗加辅助低剂量受累野放射治疗（CMT）的长期疗效。呈现无病生存和无失败生存数据、第二原发恶性肿瘤情况以及挽救治疗的结果。
1969年至1989年期间，对186例未经治疗的IIB期、III期和IV期霍奇金病患者实施CMT。化疗方案包括MVVPP（47%）、MOPP（25%）、MOPP/ABVD（26%）和ABVD（2%）。化疗6个月后，除骨髓外，对所有受累部位进行放射治疗。
所有患者的无失败生存率5年时为63%，10年时为56%，23.5年时为40%。40岁以上患者和IV期疾病患者的结果明显较差。45例复发患者的总生存率10年时为39%，但如果初始完全缓解持续时间少于1年，生存率仅为21%。迄今为止，165例实现完全缓解的患者中有21例（12.7%）发生了第二原发恶性肿瘤，16例已死亡。
与类似的化疗方案相比，化疗加放射治疗可能提高无病生存率；然而，40岁以上或IV期疾病患者的治疗结果仍然较差。尽管初始缓解持续时间超过1年的患者可以获得持久的第二次缓解，但长期无病生存率较低，在本系列中，大多数失败是由于霍奇金病复发。
