Involved-field radiotherapy is equally effective and less toxic compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavorable Hodgkin's lymphoma:: Results of the HD8 trial of the German Hodgkin's Lymphoma Study Group
Involved-field radiotherapy is equally effective and less toxic compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavorable Hodgkin's lymphoma:: Results of the HD8 trial of the German Hodgkin's Lymphoma Study Group
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DOI：
10.1200/jco.2003.03.023
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发表时间：
2003-10-01
影响因子：
45.3
通讯作者：
Diehl, V
中科院分区：
文献类型：
--
作者：
Engert, A;Schiller, P;Diehl, V
目的：调查是否可以减少放射治疗，而不损失的疗效，从扩大领域（EF）涉及领域（IF）后四个周期的chemotherapy.Patients和方法：1993年和1998年之间，新诊断的早期不利HD患者参加了这项多中心研究。患者被随机分配接受环磷酰胺、长春新碱、甲基苄肼和泼尼松（COPP）+多柔比星、博莱霉素、长春碱和达卡巴嗪（ABVD）治疗两个周期，然后对巨大病灶进行30戈伊EF + 10戈伊放疗（A组）或对巨大病灶进行30戈伊IF + 10戈伊放疗（B组）。在随机分配至治疗组的1，204例患者中，1，064例患者提供了信息，有资格进行组比较（A组532例患者; B组532例患者）。中位观察时间为54个月。随机分配后5年，所有合格患者的总生存率（OSran）为91%，无治疗失败率（FFTFran）为83%。A组和B组放疗开始后5年的生存率在FFTF（85.8%和84.2%）和5年OS（90.8%和92.4%）方面无差异。在完全缓解（98.5%和97.2%）、疾病进展（0.8%和1.9%）、复发（6.4%和7.7%）、死亡（8.1%和6.4%）和继发性肿瘤（4.5%和2.8%）方面，A组和B组之间也无差异。相比之下，急性副作用，包括白细胞减少，血小板减少，恶心，胃肠道毒性，咽部毒性更频繁的EF arm.Conclusion：放疗体积大小减少从EF到IF COPP + ABVD化疗后两个周期产生类似的结果和毒性较低的早期不利HD患者。(C)2003年，美国临床肿瘤学会。
Purpose: To investigate whether radiotherapy can be reduced without loss of efficacy from extended field (EF) to involved field (IF) after four cycles of chemotherapy.Patients and Methods: Between 1993 and 1998, patients with newly diagnosed early-stage unfavorable HD were enrolled onto this multicenter study. Patients were randomly assigned to receive cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) + doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) for two cycles followed by radiotherapy of 30 Gy EF + 10 Gy to bulky disease (arm A) or 30 Gy IF + 10 Gy to bulky disease (arm B).Results: Of 1,204 patients randomly assigned to treatment, 1,064 patients were informative and eligible for the arm comparison (532 patients in arm A; 532 patients in arm B). The median observation time was 54 months. Five years after random assignment, the overall survival (OSran) for all eligible patients was 91% and freedom from treatment failure (FFTFran) was 83%. Survival rates at 5 years after start of radiotherapy revealed no differences for arms A and B, respectively, in terms of FFTF (85.8% and 84.2%) and OS at 5 years (90.8% and 92.4%). There also were no differences between arms A and B, respectively, in terms of complete remission (98.5% and 97.2%), progressive disease (0.8% and 1.9%), relapse (6.4% and 7.7%), death (8.1% and 6.4%), and secondary neoplasia (4.5% and 2.8%). In contrast, acute side effects including leukopenia, thrombocytopenia, nausea, gastrointestinal toxicity, and pharyngeal toxicity were more frequent in the EF arm.Conclusion: Radiotherapy volume size reduction from EF to IF after COPP + ABVD chemotherapy for two cycles produces similar results and less toxicity in patients with early-stage unfavorable HD. (C) 2003 by American Society of Clinical Oncology.