ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: Long-term results
ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin's disease: Long-term results
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DOI：
10.1200/jco.2004.12.170
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发表时间：
2004-07-15
影响因子：
45.3
通讯作者：
Valagussa, P
中科院分区：
文献类型：
--
作者：
Bonadonna, G;Bonfante, V;Valagussa, P
目的单纯放射治疗（RT）可以治愈80%以上的病理分期为IA、IB和IIA的霍奇金病患者，但一些预后因素对治疗结果产生不利影响。与RT相比，联合治疗方法改善了结果，但当与化疗联合时，RT野的最佳范围需要额外的evaluation.Patients和Methods。1990年2月，我们在早期临床分期的霍奇金病患者中启动了一项前瞻性试验，以评估多柔比星、博来霉素、长春碱、结果两组患者的主要特征基本一致。完全缓解率分别为100%和97%。ABVD和STNI后12年无进展率为93%（95% CI，83%-100%），ABVD和IFRT后为94%（95% CI，88%-100%），而总生存率分别为96%（95% CI，91%-100%）和94%（95% CI，89%-100%）。除了三名患者谁开发的第二恶性肿瘤的STNI手臂，治疗相关的发病率是mild.Conclusion目前的长期研究结果表明，经过四个周期的ABVD，IFRT可以实现一个值得的结果。然而，由于我们的患者样本量有限，没有足够的统计学能力来检验IFRT与STNI相比的非劣效性。尽管如此，ABVD后IFRT可以被认为是治疗早期霍奇金病的有效和安全的方式，无论是有利的还是不利的表现。(C)2004年，美国临床肿瘤学会。
Purpose Radiation therapy (RT) alone can cure more than 80% of all patients with pathologic stage IA, IB, and IIA Hodgkin's disease, but some prognostic factors unfavorably affect treatment outcome. Combined-modality approaches improved results compared with RT, but the optimal extent of RT fields when combined with chemotherapy warranted additional evaluation.Patients and Methods In February 1990, we activated a prospective trial in patients with early, clinically staged Hodgkin's disease to assess efficacy and tolerability of four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by either subtotal nodal plus spleen irradiation (STNI) or involved-field radiotherapy (IFRT).Results Main patient characteristics were fairly well balanced between the two arms. Complete remission was achieved in 100% and in 97% of patients, respectively. The 12-year freedom from progression rates were 93% (95% CI, 83% to 100%) after ABVD and STNI, and 94% (95% CI, 88% to 100%) after ABVD and IFRT, whereas the figures for overall survival were 96% (95% CI, 91% to 100%) and 94% (95% CI, 89% to 100%), respectively. Apart from three patients who developed second malignancies in the STNI arm, treatment-related morbidities were mild.Conclusion Present long-term findings suggest that, after four cycles of ABVD, IFRT can achieve a worthwhile outcome. The limited size of our patient sample, however, had no adequate statistical power to test for noninferiority of IFRT versus STNI. Despite this, ABVD followed by IFRT can be considered an effective and safe modality in early Hodgkin's disease with both favorable and unfavorable presentation. (C) 2004 by American Society of Clinical Oncology.