The chemotherapy/radiation balance in advanced Hodgkin's lymphoma: overweight which side?
The chemotherapy/radiation balance in advanced Hodgkin's lymphoma: overweight which side?
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晚期霍奇金淋巴瘤的化疗/放疗平衡：哪一侧超重？
DOI：
10.1200/jco.2005.04.4644
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
P. Carde
中科院分区：
文献类型：
--
作者：
P. Carde
阿霉素、博来霉素、长春花碱和达卡巴嗪 (ABVD) 在不进行照射的情况下被认为是晚期霍奇金淋巴瘤 (HL) 患者的标准治疗方法。除了目前正在针对预后不良 HL 中的 ABVD 进行测试的升级博莱霉素、依托泊苷、多柔比星、环磷酰胺、长春新碱、丙卡巴肼和泼尼松 (BEACOPP) 之外，严重的挑战者还有氮芥、多柔比星、长春碱、长春新碱、博来霉素、依托泊苷和泼尼松 (Stanford V)，以及几种多药治疗方案（MDR），这是 Gobbi 等人和 Johnson 等人在本期《临床肿瘤学杂志》上发表的两篇报告的主题。通过这些文章，我希望提请大家注意研究者提出的关于中晚期 HL 联合化疗和放疗的相关问题。 Gobbi 等人认为，Stanford V 治疗方案中的化疗部分（在全球范围内普遍用于治疗晚期霍奇金淋巴瘤）与更古老的 ABVD 方案以及主要由意大利淋巴瘤使用的氮芥、洛莫司汀、长春地辛、美法仑、强的松、表柔比星、长春新碱、丙卡巴肼、长春花碱、博莱霉素 (MOPPEBVCAD) 所获得的结果相比，其效果较差。研究组（IIL）。斯坦福 V 用户可以放心：本研究中使用的斯坦福 V 是故意与原始版本不同的。其目的当然不是让一种疗法相对于自制方案处于不利地位。 IIL 旨在为晚期 HL 患者确定最佳的化疗方案，并完全取消放疗或大幅减少照射野。由于研究设计的原因，这一目标并未实现，其中三个随机组中每组的照射情况都不同。因此，如果霍宁报告的结果是预期的，我建议使用最初的斯坦福 V 计划（而不是修改后的方案）。 Gobbi 等人的文章旨在研究三种化疗方案中哪一种本身更优越；也就是说，与最初的化疗/放疗组合相比，哪种方案允许较少频繁地使用辐射，并且当使用辐射时，允许对辐射野范围有更大的限制。与文献中报道的大多数照射方式相比，照射成分被有意减少，尽管令人难以置信的广泛剂量和领域被描述为晚期疾病的辅助治疗或巩固。事实上，在 Gobbi 等人的研究中，当达到完全缓解（CR）时就不允许进行照射。当获得部分缓解（PR）或未确认完全缓解（CRu）时，仅对那些受累部位不超过两个需要照射的患者进行照射；这也意味着最多可以照射两个相关部位（36 至 42 Gy），考虑到最初的大体积部位加上残留的 CRu/PR 疾病。因此，不幸的是，由于化疗后重新分期时残留疾病而最需要放射治疗的患者，尤其是那些 CRu/PR 部位很少的患者，也没有资格接受放射治疗。还应该强调的是，化疗仅限于 6 个月的 ABVD 或 MOPPEBVCAD 周期，或 12 周的斯坦福 V 化疗，而许多研究人员建议进行 8 个月的标准剂量化疗 (ABVD)。 IIL 结果显示，就无失败生存期 (FFS) 而言，两种 6 个月的治疗方案（与不同剂量的照射相结合）优于 3 个月的改良斯坦福 V 治疗方案，而就 ABVD 而言，就总生存率而言（OS；P < .04）。为了正确解释数据，应该指出 IIL 研究存在两个缺点。第一个是患者分布在每臂患者数量和结节性硬化组织学或巨大纵隔疾病方面存在一些不平衡。更重要的是，决定是否进行放射治疗的过程《临床肿瘤学杂志》编辑第 23 卷，第 36 期，12 月 2 日
Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), without irradiation, is considered standard treatment for responding patients with advanced Hodgkin’s lymphoma (HL). Apart from escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP), which is now being tested against ABVD in poor-prognosis HL, serious challengers are mechlorethamine, doxorubicin, vinblastine, vincristine, bleomycin, etoposide, and prednisone (Stanford V), and several multidrug regimens (MDRs), which are the subject of the two reports in this issue of the Journal of Clinical Oncology by Gobbi et al and Johnson et al. Through these articles, I wish to draw attention to the pertinent questions asked by the investigators regarding combined chemotherapy and irradiation for intermediate and advanced HL. Gobbi et al suggest that the chemotherapy part of the Stanford V treatment program, which is commonly used worldwide for advanced Hodgkin’s lymphoma, provides inferior results compared with those obtained by the much older ABVD regimen, and by mechlorethamine, lomustine, vindesine, melphalan, prednisone, epidoxorubicin, vincristine, procarbazine, vinblastine, bleomycin (MOPPEBVCAD), primarily used by the Italian Lymphoma Study group (IIL). Stanford V users can be reassured: the Stanford V used in this study was intentionally different from the original. The aim certainly was not to disadvantage one regimen against homemade protocols. The IIL intended to determine the best possible chemotherapy regimen for advanced HL patients and either to remove radiotherapy completely or to reduce drastically the irradiation fields. This was not achieved, due to the design of the study, in which the irradiation was different in each of the three randomized groups. Therefore, I recommend that the original Stanford V program—not a modified regimen—be used if outcomes reported by Horning are expected. The article by Gobbi et al aimed to investigate which of three chemotherapy regimens was superior by itself; that is, which regimen allowed a less frequent usage of irradiation, and when radiation was used, allowed a greater limitation of the irradiation field extent than in the original chemotherapy/radiotherapy combinations. The irradiation component was reduced intentionally, as compared with most irradiation modalities reported in the literature, although an incredibly broad spectrum of doses and fields are described as adjuvant treatment or consolidation for advanced disease. Indeed, in the study by Gobbi et al, no irradiation was allowed when a complete remission (CR) was achieved. When a partial remission (PR) or complete remission unconfirmed (CRu) was obtained, irradiation was administered only to those patients who had no more than two involved sites to irradiate; this meant also that a maximum of two involved sites could be irradiated (36 to 42 Gy), taking into account initial bulky site(s) plus residual CRu/PR disease. As a consequence, patients who otherwise would most require irradiation because of residual disease at the time of restaging after chemotherapy, especially those with few CRu/PR sites, were also, unfortunately, ineligible for irradiation. It should also be emphasized that chemotherapy was restricted to either 6 monthly cycles of ABVD or MOPPEBVCAD, or to 12 weeks of Stanford V chemotherapy, whereas many investigators recommend 8 months of standard-dose chemotherapy (ABVD). The IIL results show that the two 6-month regimens (when combined with different amounts of irradiation) fared better than the 3-month modified Stanford V regimen, in terms of failure-free survival (FFS), and for ABVD, in terms of overall survival (OS; P .04). For a correct interpretation of the data, it should be noted that the IIL study suffered from two drawbacks. The first was some imbalance in the distribution of the patients regarding patient numbers per arm and nodular sclerosis histology or bulky mediastinal disease. More importantly, the process that led to the decision of whether to administer radiation JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L VOLUME 23 NUMBER 36 DECEMBER 2
影响因子：
45.3
作者：
Horning, SJ;Wiliams, J;Cassileth, P
通讯作者：
Cassileth, P
影响因子：
45.3
作者：
Duggan, DB;Petroni, GR;Peterson, BA
通讯作者：
Peterson, BA
斯坦福 V 和放疗治疗局部广泛和晚期霍奇金病：前瞻性临床试验的成熟结果。
DOI：
10.1200/jco.2002.20.3.630
发表时间：
2002
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Horning,SandraJ;Hoppe,RichardT;Breslin,Sheila;Bartlett,NancyL;Brown,BWilliam;Rosenberg,SaulA
通讯作者：
Rosenberg,SaulA