VAMP and low-dose, involved-field radiation for children and adolescents with favorable, early-stage Hodgkin's disease: Results of a prospective clinical trial
VAMP and low-dose, involved-field radiation for children and adolescents with favorable, early-stage Hodgkin's disease: Results of a prospective clinical trial
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DOI：
10.1200/jco.2002.12.101
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发表时间：
2002-07-15
影响因子：
45.3
通讯作者：
Weinstein, HJ
中科院分区：
文献类型：
--
作者：
Donaldson, SS;Hudson, MM;Weinstein, HJ
目的：评价长春新碱、阿霉素、甲氨蝶呤、强的松(VAMP)联合低剂量累及野放疗治疗早期Hodgkin病的疗效和毒性。患者和方法：110例临床I期和11期的Hodgkin病患者接受4个周期的VAMP化疗，完全缓解者接受15个周期的累及野放疗，或对两个周期的VAMP取得部分应答者进行25.5个疗程的随访期。结果：中位随访期5.6年(范围，5年生存率99%(可信区间下限97.4%)，无事件生存率93%(可信区间下限88.6%)。与100%无事件存活率相关的因素是对两个VAMP周期的完全反应和组织学，而不是结节硬化性霍奇金病(NSHD)。没有观察到严重的早期或晚期毒性。临床表现为I期和IIA期的非肿块性疾病患者5年的预计存活率和无事件存活率分别为100%和97%(CL较低，93%)。结论：早期/良性霍奇金病患者仅使用4个周期的VAMP化疗和15~25.5Gy受累野放射治疗是有效的，且没有明显的副作用。这些结果表明，具有I期和11期良好霍奇金氏病的儿童患者可以通过有限的治疗治愈，这种治疗不包括烷化剂、博莱霉素、依托泊苷或大剂量、扩大视野的放射治疗。(C)2002年，由美国临床肿瘤学会提供。
Purpose: To evaluate outcome and assess toxicity of children and adolescents with early-stage, favorable Hodgkin's disease treated with vinblastine, doxorubicin, methotrexate, and prednisone (VAMP) and low-dose, involved-field radiation.Patients and Methods: One hundred ten patients with clinical stages I and 11, favorable (nonbulky) Hodgkin's disease were treated with four cycles of VAMP chemotherapy and 15 Gy involved-field radiation for those who achieved a complete response, or 25.5 Gy for those who achieved a partial response to two cycles of VAMP.Results: With a median follow-up of 5.6 years (range, 1.1 to 10.4 years), the 5-year survival and event-free survival were 99% (lower confidence limit [CL], 97.4%) and 93% (lower CL, 88.6%), respectively. Factors associated with event-free survival of 100% were complete response to two cycles of VAMP and histology other than nodular sclerosing Hodgkin's disease (NSHD). No serious early or late toxicity has been observed. Patients presenting with clinical stages I and IIA, nonbulky disease involving fewer than three nodal sites have a projected survival and event-free survival of 100% and 97% (lower CL, 93%), respectively, at 5 years.Conclusion: Risk-adapted, combined-modality therapy using only four cycles of VAMP chemotherapy with 15 to 25.5 Gy of involved-field radiation for patients with early-stage/favorable Hodgkin's disease is highly effective and without demonstrable late effects. These results indicate that pediatric patients with stages I and 11 favorable Hodgkin's disease can be cured with limited therapy that does not include an alkylating agent, bleomycin, etoposide, or high-dose, extended-field radiation therapy. (C) 2002 by American Society of Clinical Oncology.