化疗与相关区域放疗结合是早期霍奇金淋巴瘤患者的最佳选择

2007-11-22 12:31:32   作者：   文字大小：【大】【中】【小】

关键字：霍奇金淋巴瘤

NEW YORK (Reuters Health) - Patients with early-stage Hodgkin's disease have better outcomes when chemotherapy is followed by involved-field radiotherapy rather than subtotal nodal radiotherapy, physicians in Europe report, which applies to patients with favorable or unfavorable characteristics.
纽约（路透社 健康）欧洲医学专家报告说，早期霍奇金淋巴瘤的患者，如果在化疗之后进行相关区域的放射治疗，而非全淋巴结放疗，将取得更好的治疗效果。这个做法对情况较好和较差的患者都适用。

Dr. Christophe Ferme and colleagues reviewed the outcomes of 1,538 patients with untreated stage I or II supradiaphragmatic Hodgkin's disease who were treated between 1993 and 1999. On the basis of initial clinical and biologic features, 542 were classified as having a favorable prognosis and 996 as having an unfavorable prognosis.
Christophe Ferme博士和他的同事回顾了1538名治疗前为Ⅰ期或Ⅱ期的膈上霍奇金淋巴瘤患者，他们在1993年到1999年间进行了治疗。在最初的临床和生物学表现的基础上，542人被认为有较好的预后，而996人的预后较差。

Patients with favorable features were randomized to subtotal nodal radiotherapy or three cycles of chemotherapy plus involved-field radiotherapy. Those with unfavorable features were randomized to four or six cycles of chemotherapy plus involved field radiotherapy or subtotal nodal radiotherapy.
情况较好的患者被随机进行全淋巴结放疗，或三疗程化疗加相关区域放疗。情况较差的患者被随机进行四疗程或六疗程化疗加相关区域放疗，或全淋巴结放疗。

Chemotherapy consisted of MOPP-ABV (mechlorethamine, vincristine, procarbazine, prednisone -- doxorubicin, bleomycin and vinblastine). Median follow-up was 92 months.
化疗方案为MOPP-ABV方案（氮芥、长春新碱、甲基苄肼、强的松，阿霉素、博莱霉素和长春花碱）。跟踪期中位为92个月。

In the group with favorable features, 5-year event-free survival was significantly greater after treatment with three cycles of MOPP-ABV plus involved-field radiotherapy than after subtotal nodal radiotherapy alone (98% versus 74%, p < 0.001). Estimated 10-year overall survival rates were 97% and 92%, respectively, (p = 0.001).
在情况较好的病人组中，三疗程MOPP-ABV化疗加相关区域化疗组的治疗后五年无病生存率明显高于只做全淋巴结放疗的治疗组（98%:74%，p<0.001）。估测十年总生存率分别为97%和92%（p=0.001）。

In the group with unfavorable features, 5-year event-free survival and estimates of 10-year overall survival were similar in all treatment groups and for each time period, ranging from 84% to 88%.
在情况较差的病人组中，所有组的五年无病生存率以及估测十年总生存率在每个时间段内均相差不多，在84%到88%之间。

Dr. Ferme's group recommends that for patients with early-stage Hodgkin's disease, "chemotherapy plus involved-field radiotherapy should be the standard treatment." They further advise that chemotherapy be limited to four cycles in patients, even in those with unfavorable features, to minimize treatment side effects.
Ferme博士的小组建议，化疗联合相关区域放疗应当成为对早期霍奇金淋巴瘤患者的标准治疗方法。他们进一步建议说，对病人的化疗应该被限制在四个疗程以内，即使对情况不理想的患者也是如此，以将治疗副作用降到最低。

In a related editorial, Dr. Volker Diehl, at the University of Cologne in Germany, points out that the MOPP-ABV regimen has been replaced with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) for patients with early-stage disease to avoid the long-term increased risk of other cancers.
德国科隆大学的Volker Diehl博士在一个相关的评论中指出，对于早期患者，MOPP-ABV方案已经被ABVD方案（阿霉素、博莱霉素、长春花碱和氮烯咪胺）所替代，这个方案能避免患者患其他癌症的长期风险的增加。

With the advent of a sensitive metabolic imaging technique -- positron-emission tomography with F-18-fluorodeoxyglucose (PET-FDG) with computed tomography -- to follow patients' response to treatment, some may also be spared prolonged chemotherapy or radiotherapy.
当前出现了一种灵敏的代谢影像技术——计算机成像氟[F18]脱氧葡萄糖正电子发射体层摄影术。这种技术可以很好地跟踪患者的治疗反应。在这个技术的帮助下，一些病人可能可以省去长时间的化疗或放疗。