ALTERNATING CHEMOTHERAPY AND IRRADIATION IN THE TREATMENT OF ADVANCED HODGKINS-DISEASE
ALTERNATING CHEMOTHERAPY AND IRRADIATION IN THE TREATMENT OF ADVANCED HODGKINS-DISEASE
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DOI：
10.1002/1097-0142(197902)43:2
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发表时间：
1979-01-01
期刊：
影响因子：
6.2
通讯作者：
KAPLAN, HS
中科院分区：
文献类型：
--
作者：
HOPPE, RT;PORTLOCK, CS;KAPLAN, HS
从1974年7月到1977年4月，25名IIIB期或IIISB期霍奇金病患者进入了一项前瞻性试验，以评估一种新的联合治疗方案的疗效。患者接受MOP(P)（氮芥、长春新碱、丙卡嗪和强的松）或PAVe（丙卡嗪、1-苯丙氨酸芥和长春碱）治疗。放射场为总淋巴（套膜和倒Y），通常剂量为4000-4400 rad。患者最初采用分疗程治疗，6个药物周期夹在总淋巴照射周围。为了最大限度地减少患者不接受全身治疗的时间，并最大限度地提高化疗的剂量，随后采用了一种交替的方法。采用该技术，将总淋巴区分为3个区域，每个区域的治疗交替进行2个周期的化疗，直到整个方案完成。治疗持续时间为9-18个月。分开疗程组患者平均接受其计算总药物剂量的65%，交替疗程组患者平均接受76.5%。主要并发症为血液学，平均最低记录白细胞计数为2200/mm3，血小板计数为101000 /mm3。在25名患者中，22名患者实现了最初的完全缓解，20名患者仍然没有疾病，中位随访间隔为28个月。包括一名在治疗前死亡的患者在内的整个组的精算生存率为84%，而实现完全缓解的患者为100%。在同一组中，复发自由率分别为79%和90%。这些结果比较了以往使用全淋巴细胞照射和全淋巴细胞照射后辅助MOP(P)化疗的经验。化疗与放疗交替技术是可行的，为其他恶性肿瘤的联合治疗提供了一种模式。
From July 1974 through April 1977, 25 patients with stage IIIB or IIISB Hodgkin''s disease were entered into a prospective trial to assess the efficacy of a new combined modality treatment program. Patients received either MOP(P) (nitrogen mustard, vincristine, procarbazine and prednisone) or PAVe (procarbazine, 1-phenylalanine mustard and vinblastine). The radiation fields were total lymphoid (mantle and inverted Y) and the usual dose was 4000-4400 rad. Patients initially were treated in a split course fashion with 6 drug cycles sandwiched around total lymphoid irradiation. To minimize the length of time that patients were without systemic therapy and to maximize the doses of chemotherapy that could be administered, an alternating approach was subsequently adopted. With this technique, the total lymphoid fields were divided into 3 regions and treatment to each was alternated with 2 cycles of chemotherapy until the entire program was complete. The duration of therapy ranged 9-18 mo. Patients in the split course group received an average of 65% of their calculated total drug doses and those in the alternating group received an average of 76.5%. The primary complication was hematologic, with mean lowest recorded white cell count of 2200/mm3 and platelet count of 101,000/mm3. Of 25 patients, 22 achieved an initial complete remission and 20 remain free of disease with a median follow-up interval of 28 mo. Actuarial survival for the entire group including a patient who died prior to the institution of therapy, is 84%, while for those who achieved a complete remission it is 100%. Figures for freedom-from-relapse in the same groups are 79% and 90%, respectively. These results are compared to previous experience using total lymphoid irradiation alone and total lymphoid irradiation followed by adjuvant MOP(P) chemotherapy. The alternating technique for combining chemotherapy and irradiation is feasible and provides a model for combined modality therapy in patients with other malignancies.