Hodgkin's disease with a mediastinal mass greater than 10 cm: results of four different treatment approaches.
Hodgkin's disease with a mediastinal mass greater than 10 cm: results of four different treatment approaches.
复制标题
纵隔肿块大于 10 厘米的霍奇金病：四种不同治疗方法的结果。
作者：
A. Preti;F. Hagemeister;P. Mclaughlin;F. Swan;A. Rodríguez;P. Besa;J. Cox;P. Allen;F. Cabanillas
背景
霍奇金病 (HD) 和大型纵隔腺病 (LMA) 的治疗通常包括强化化疗 (CT) 联合或不联合放射治疗 (XT)，无论分期如何。
患者和方法
118 名可评估患者接受了四种治疗方案之一：(1) 6 个周期的 MOPP 或类似的 CT 和 XT； (2) 2个MOPP，然后是XT； (3) 6 份 CVPP/ABDIC（环磷酰胺、长春新碱、丙卡巴肼、泼尼松/多柔比星、博来霉素、达卡巴嗪、泼尼松、洛莫司汀），然后是 XT；或(4)NOVP(米托蒽醌、长春新碱、长春花碱、丙卡巴肼)和XT中的3种。 XT 剂量包括对治疗前注意到的淋巴结受累区域进行 30-40 Gy 的照射。
结果
第 1、2、3 和 4 组的完全缓解 (CR) 率分别为 100%、85%、87% 和 96%。 3年无进展（FFP）结果分别为88%、66%、82%和88%，3年无肿瘤死亡率（FTM）结果分别为100%、84%、84%和100%。 B 症状和 IV 期疾病的存在与较低的 CR 和 3 年 FFP 率相关，但 3 年生存率相似。
结论
这项研究的结果表明，患有 I-III 期霍奇金病且 LMA 大于 10 cm 的患者接受 3 NOVP 和 XT 治疗，其结果与接受 2 至 6 MOPP 或 6 CVPP/ABDIC 和 XT 治疗的类似患者组获得的结果相似。据报道，在该试验中，NOVP 产生的毒性有限，在治疗早期疾病且 LMA 大于 10 cm 的患者时，应考虑将其作为 MOPP 或含阿霉素方案的替代方案。
BACKGROUND
Management of Hodgkin's disease (HD) and large mediastinal adenopathy (LMA) usually includes intensive chemotherapy (CT) with or without radiation therapy (XT) regardless of stage.
PATIENTS AND METHODS
One hundred and eighteen evaluable patients received one of four treatment regimens: (1) 6 cycles of MOPP or similar CT and XT; (2) 2 of MOPP followed by XT; (3) 6 of CVPP/ABDIC (cyclophosphamide, vincristine, procarbazine, prednisone/doxorubicin, bleomycin, decarbazine, prednisone, lomustine) followed by XT; or (4) 3 of NOVP (mitoxantrone, vincristine, vinblastine, procarbazine) and XT. XT doses included 30-40 Gy to areas of nodal involvement noted prior to therapy.
RESULTS
Complete remission (CR) rates for groups 1, 2, 3, and 4 were 100%, 85%, 87%, and 96%. Respective 3-year freedom from progression (FFP) results were 88%, 66%, 82%, and 88%, and 3-year freedom from tumor mortality (FTM) results were 100%, 84%, 84%, and 100%. The presence of B symptoms and stage IV disease was correlated with lower CR and 3-year FFP rates but similar 3-year survival.
CONCLUSIONS
Results of this study suggest that patients with stage I-III Hodgkin's disease and LMA greater than 10 cm treated with 3 NOVP and XT have results similar to those obtained for a similar group of patients treated with 2 to 6 MOPP or 6 CVPP/ABDIC and XT. NOVP has also been reported to produce limited toxicity in this trial and should be considered as an alternative to MOPP or doxorubicin-containing regimens in treatment of patients with early-staged disease and LMA greater than 10 cm.