化疗联合斗篷野或累及野放疗治疗早期何杰金淋巴瘤的疗效比较

Comparison of Effect of Chemotherapy Combined with Mantle and with Involved Irradiation in Early Hodgkin’s Disease

目的 :比较早期何杰金淋巴瘤 (HD)化疗联合不同照射体积的照射野放疗的疗效 ,研究早期HD的最佳放疗方法。方法 :从 1990年 1月 2 0 0 0年 6月本科收治的 4 3例早期HD患者 ,按放疗方法分为化疗 +斗篷野放疗 (斗篷野治疗组 ) 2 7例和化疗 +累及野放疗 (累及野治疗组 ) 16例。化疗方案选用ABVD、MOPP或两者交替使用 ,放疗前予 2 4周期化疗 ,放疗后补充 0 2周期化疗。结果 :4 3例患者中位随访时间为 74月 ,斗篷野治疗组 5年、10年生存率分别为 95 .0 %和 85 .0 % ,5年、10年无瘤生存率分别为 87.19%和 78.4 7% ;累及野治疗组 5年、10年生存率分别为 92 .31%和 80 .7% ,5年、10年无瘤生存率分别为 87.0 3%和 6 0 .2 9%。两组生存率和无瘤生存率均无明显差异 (P>0 .0 5 )。斗篷野治疗组 1例野内复发 ,1例野外复发 ,2例野内和野外复发 ;累及野治疗组 1例野内复发 ,3例野内和野外复发。累及野治疗组骨髓抑制、放射性肺炎和放射性皮肤粘膜反应较斗篷野治疗组明显下降 ,甲减的发生率两组相似 ,尚未观察到第二原发肿瘤。结论 :为减少早期HD放疗并发症 ,累及野放疗是安全、可行的。

Objective: To compare the effect of chemotherapy combined with mantle irradiation and combined with involved irradiation in early Hodgkin’s disease(HD) retrospectively to find a better treatment method. Methods: From January, 1990 to June, 2000, 43 patients with HD, clinical stage (CS) Ⅰ~Ⅱ, had been treated at the radiochemotherapy department. Overall treatment consisted of chemotherapy + mantle irradiation (mantle group, 27 patients) and chemotherapy + involved field irradiation (involved field group, 16 patients). Chemotherapy regimen was ABVD or MOPP, 2 ~ 4 cycles chemotherapy followed by irradiation, and then treated by 0~2 cycles chemotherapy. Results: Median follow-up time was 74 months. The results of mantle group and involved field group were compared as following: 5-year survival was 95.0% and 92.31%, respectively; 10-year survival was 85.0% and 80.7%, respectively; 5-year disease-free survival was 87.19% and 87.03%, respectively; 10-year disease-free survival was 78.47% and 60.29% , respectively. There were no significantly differences between the two groups. The difference was not significant between the two groups in the rate of relapse. Except for hypothyroidism, the other side-effects had significant difference between the two groups. Conclusion: Because of the serious long-term side-effects of mantle irradiation and the same side-effects by reduction of the volume irradiation, the treatment of chemotherapy combination with limited radiotherapy for early-stage patients is superior.