Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate-and high-grade non-Hodgkin's lymphoma
Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate-and high-grade non-Hodgkin's lymphoma
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DOI：
10.1056/nejm199807023390104
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发表时间：
1998-07-02
影响因子：
158.5
通讯作者：
Fisher, RI
中科院分区：
文献类型：
--
作者：
Miller, TP;Dahlberg, S;Fisher, RI
背景：临床局限性、中度或高度非霍奇金淋巴瘤患者通常接受含阿霉素的方案（如环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP））的初始治疗。试点研究表明，8个周期的CHOP单独或3个周期的CHOP，然后涉及领域的放疗是有效的，在这样的patients.Methods我们比较了这两种方法在一个前瞻性的，随机的，多机构的研究。终点是无进展生存期、总生存期和危及生命或致命的毒性作用。结果CHOP联合放疗3个周期的患者无进展生存率（P=0.03）和总生存率（P =0.02）明显高于CHOP单药治疗的患者。接受CHOP加放疗和单独接受CHOP的患者的五年无进展生存率估计分别为77%和64%。接受CHOP加放疗和单独接受CHOP的患者的五年总生存率估计分别为82%和72%。不良反应包括每个治疗组各1例死亡。CHOP联合放疗组200例患者中有61例出现任何类型的危及生命的毒性反应，而CHOP单药组201例患者中有80例出现任何类型的危及生命的毒性反应（P=0.06）。单纯CHOP组7例患者左心功能下降，而CHOP加放疗组无心脏事件发生（P=0.02）。结论CHOP 3个周期后再行累及野放疗治疗局限性中、高度非霍奇金淋巴瘤上级单纯CHOP 8个周期。（N Engl J Med 1998;339：21-6.）(C)1998年，马萨诸塞州医学会。
Background Patients with clinically localized, intermediate- or high-grade non-Hodgkin's lymphoma usually receive initial treatment with a doxorubicin-containing regimen such as cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP). Pilot studies suggest that eight cycles of CHOP alone or three cycles of CHOP followed by involved-field radiotherapy are effective in such patients.Methods We compared these two approaches in a prospective, randomized, multi-institutional study. The end points were progression-free survival, overall survival, and life-threatening or fatal toxic effects. Two hundred eligible patients were randomly assigned to receive CHOP plus radiotherapy, and 201 received CHOP alone.Results Patients treated with three cycles of CHOP plus radiotherapy had significantly better progression-free survival (P=0.03) and overall survival (P=0.02) than patients treated with CHOP alone. The five-year estimates of progression-free survival for patients receiving CHOP plus radiotherapy and for patients receiving CHOP alone were 77 percent and 64 percent, respectively. The five-year estimates of overall survival for patients receiving CHOP plus radiotherapy and for patients receiving CHOP alone were 82 percent and 72 percent, respectively. The adverse effects included one death in each treatment group. Life-threatening toxic effects of any type were seen in 61 of 200 patients treated with CHOP plus radiotherapy and in 80 of 201 patients treated with CHOP alone (P=0.06). The left ventricular function was decreased in seven patients who received CHOP alone, whereas no cardiac events were recorded in the group receiving CHOP plus radiotherapy (P=0.02).Conclusions Three cycles of CHOP followed by involved-field radiotherapy are superior to eight cycles of CHOP alone for the treatment of localized intermediate- and high-grade non-Hodgkin's lymphoma. (N Engl J Med 1998;339:21-6.) (C) 1998, Massachusetts Medical Society.