晚期何杰金氏病综合治疗93例

COMBINED MODALITY THERAPY FOR ADVANCED HODGKIN'S DISEASE (HD)

分析我院1974年4月至1988年6月收治93例Ⅲ,Ⅳ期何杰金氏病患者,所有病例均做大面积不规则野放射治疗。放疗前后加用2～3疗程的COPP或MOPP化疗。Ⅲ期病人5年生存率为72.1％,Ⅳ期为18.2％。完全缓解率(CR)Ⅲ期为76.4％,Ⅳ期为31.6％,总复发率为33.3％。Ⅲ期患者预后显著优于Ⅳ期患者。年龄、有无下腹部侵犯均影响预后,而有无全身症状则与预后无关。Ⅲ期病人有切脾指征时应行剖腹探查和脾切除术,对明确病变范围从而指导临床治疗方案的选择有价值。我们认为化疗+全淋巴结照射+化疗是治疗Ⅲ期患者的有效方法,大纵隔或肺门淋巴结侵犯者应行同侧肺预防性照射,脾肿大、持续发热或脾侵犯者应予肝预防性照射。Ⅳ期病人放疗难以控制病情,应以化疗为主,对缓解病例可行局部补充照射,以提高生存率。

This paper analyses the results of large irregular field irradiation for 93 patients with stages Ⅲ-Ⅳ HD treated from 1974 to 1988. These patients were also given chemothrapy with 2-3 cycles of COP(P) or MOP(P) before or after radiation. Five-year survival rates of stage Ⅲ and stage Ⅳ patients were 72.1% and 18. 2%, respectively. Complete response rate of stage Ⅲ patients was 76. 4% and stage Ⅳ 31. 6%. Total relapse rate was 33. 3%. The authors suggest that abdominal exploration and splenectomy be performed in order to locate the lesions and to guide therapy in stage Ⅲ patients. It was difficult for radiotherapy to arrest stage Ⅳ lesions with extensive visceral involvement. Yet, local complementary radiation for-regressed lesions after chemotherapy was valuable.