早期霍奇金病的放射治疗

目的 对膈上型早期霍奇金病的放射治疗方法及疗效进行探讨。方法 本院共收治１５例以上的早期霍奇金病（ＨＤ）患者５４例，其中≤３３岁者２６例，〉３３岁者２８例，所有患者均经病理证实，淋巴细胞为主型（ＬＰ）＋结节硬化型（ＮＳ）共２７例，混合细胞型２７例。大部分患者接受单纯放射治疗（４５／５４），仅少部分为放射治疗＋不规则化疗治疗（９／５４），其中斗蓬野（ＭＦ）放射治疗者２０例，次全淋巴结照射（ＳＴＮ）者     

放射治疗和化疗治疗局部晚期胰腺癌的临床分析

目的：分析放射治疗和PDD、5－FU同期化疗后巩固化疗治疗不能切除的局部晚期胰腺癌的临床受益情况。方法：32例不能切除的局部晚期胰腺癌患者接受放射治疗45Gy和PDD,5－FU同期化疗2个周期,3周后进行同方案化疗加甲酰四氢叶酸巩固治疗4个周期。通过治疗前后镇痛剂用量,一般情况（卡氏评分）和体重变化计算临床受益指数,并根据影像学（CT）肿瘤变化判断肿瘤切除的可能性。结果：中位生存9个月,1年生存率为31．3％（10／32）,2年生存率为9．4％（3／32）。治疗中镇痛剂用量下降≥50％17例,一般情况改善,卡氏评分上升20分以上4例;体重增加≥7％4例。其中12例在镇痛剂用量,体重和一般情况3项中至少有1项改善而无任何1项恶化,这样得出本治疗方法的临床受益指数为37．5％。另外治疗法CT复查,6例肿瘤缩小≥75％（PR）,6例肿瘤进展;3例治疗后手术切除肿瘤,其中1例病理学检查无癌细胞,这样本方法治疗后肿瘤切除的可能性为9．3％（3／32）。结论：本方法能明显减轻局部晚期胰腺癌患者的疼痛,但对治疗后肿瘤切除作用较小。     

磁共振成象对成人早期霍奇金病放射治疗疗效的评估价值

目的　测量 60例成人早期霍奇金病 (HD)放疗前后磁共振成像 (MRI)信号强度 (SI)的变化 ,标定放疗后肿瘤组织纤维化的程度 ,从而准确评估放疗对成人早期HD的疗效。方法　应用MRI的自动测量系统 ,在放疗前后分别测量肿瘤、皮下脂肪及肌肉的SI ,分别用脂肪和肌肉的SI除以肿瘤的相应测量值而得到标准化值。结果　放疗后肿瘤SI的脂肪和肌肉的标准化值的均数及标准差分别为 0 .4± 0 .3和 1.8± 1.2 ,比放疗前的标准化值明显减小 (P值 <0 .0 1)。结论　MRISI的测量可准确评估成人早期HD的放疗效果 ,其T2 加权图像 (T2 WI)可对纤维组织和残留或复发的肿瘤组织作出鉴别。     

Ⅰ、Ⅱ期霍奇金病放射治疗长期生存的分析

目的评价Ⅰ、Ⅱ期霍奇金病采用扩大照射（ＥｘｔｅｎｄｅｄＦｉｅｌｄ，ＥＦ）、次全淋巴结照射（ＳｕｂｔｏｔａｌＮｏｄａｌＩｒａｄｉａｔｉｏｎ，ＳＴＮＩ）及全淋巴结照射（ＴｏｔａｌＮｏｄａｌＩｒｒａｄｉａｔｉｏｎ，ＴＮＩ）不同方案放射治疗的长期疗效。材料与方法１９７４年４月至１９８９年２月收治的１９１例Ⅰ、Ⅱ期霍奇金病患者，所有病例均做大面积不规则野放射治疗。其中ＥＦ共３９例，ＳＴＮＩ共８８例，ＴＮＩ共６４例。结果发现总复发率和野外复发率在ＥＦ组高于ＳＴＮＩ组或ＴＮＩ组（Ｐ＜０．０５），在ＳＴＮＩ和ＴＮＩ组的总复发率和野外复发率大致相同。ＳＴＮＩ及ＴＮＩ组的５年、１０年及１４年生存率均高于ＥＦ组，虽仅ＴＮＩ组的５年生存率较ＥＦ的５年生存率差异有显著性意义（Ｐ＜０．０５），但仍提示ＥＦ组的照射范围是不够的。Ⅰ期病人５年、１０年和１４年生存率分别为９３．２％、８７．５％和７４．５％，Ⅱ期分别为８８．３％、７８．６％和７８．６％。结论本组结果显示早期霍奇金病采用放射治疗有较好的长期生存率，治疗方案宜采用ＳＴＮＩ为好。     

从“做减法”的角度看直肠癌放射治疗

结直肠癌（colorectal cancer,CRC）是最常见的消化道恶性肿瘤。随着饮食习惯和饮食结构的改变以及人口老龄化,国内外数据均显示其发病率和死亡率呈上升趋势。2013年CRC已跃居美国第4位常见肿瘤及第2位肿瘤死因[1]。2009年我国CRC发病率达29.44/10万,位居我国常见肿瘤的第3位,死亡率达14.23/10万,位居肿瘤死因的第5位[2,3]。当前,     

鼻腔非霍奇金淋巴瘤的化学治疗及放射治疗

目的 探讨不同治疗方法对鼻腔非霍奇金淋巴瘤(NHL)患者的预后影响。方法 在59例原发于鼻腔NHLIE期患者中,化疗 放疗33例,放疗 化疗8例,单纯化疗10例,单纯放疗8例,化疗方案为CHOP.结果 全组患者的l,3,5年生存率分别为71．2％、42．0％和38．5％,不同治疗方法的生存率差异无显著性(P=0．3943),但生存曲线显示,放化组优于其他组。临床分期显示,Ig局限组患者l,3,5年生存率为84．2c／／,67．7％和62．0%,,Ig超腔组患者为50．0％、14．3％和14．3％,差异有显著性(P=0．0012)。首程化疗≥3个周期24例,首程放疗≥40 Gy16例,CR率分别为25．0v／／,和75．0％,筹异有显著性(P=0．002)。首程化疗2,3～4,5～6个周期的CR率分别为10．5％、25．0％和25．0％,差异无显著性(P=0．48)。并发症发生率及治疗相关死亡率均以化放组为高(39．4％,15．2％),但差异无显著性(P=0．202,P=0．693)。结论 Ⅰ期鼻腔NHL患者首选放疗,以尽早达到局部控制,再根据临床分期及恶性程度或国际预后指数(IPI)酌情给予更有效的化疗方案。     

何杰金病的放射治疗

1940年Craft报告了52例未经治疗的何杰金病,其5年生存率为5.8％,另一组179例经X线治疗其5年生存率为23.4％,说明X线对何杰金病具有治疗价值。1950年Peter报告113例何杰金病经放射治疗其5年生存率为51％,直到这时放射治疗对何杰金病的价值才得到重视。近20年来何杰金病的治疗效果有显著的提高。在国际上总的5年生存率为70～80％,Ⅰ、Ⅱ期的5年生存率为80～90％。本院Ⅰ、Ⅱ     

早期霍奇金病综合治疗中受累野照射的临床疗效

目的 评价Ⅰ、Ⅱ期霍奇金病（HD）患者综合治疗时受累野照射的疗效和毒副作用,并与扩大野照射进行比较。方法 早期HD 88例,根据Ann Arbor分期,ⅠA期12例（13．7％）,ⅡA期56例（63．6％）,ⅡB期20例（22．7％）。全部患者接受化疗和放疗综合治疗,先化疗后放疗患者83例,先放疗后化疗患者5例。化疗多采用ABVD或ABVD／MOPP方案;受累野照射42例,扩大野照射46例。结果 全组有6例膈上原发HD治疗后复发,受累野组和扩大野组各3例。扩大野组有1例照射野内复发,受累野组有1例在邻近照射部位的腋窝复发,其余4例患者均表现为结外器官或膈下淋巴结受侵。全组患者1、2、3年总生存率分别为100．0％、98．6％和96．3％,受累野组患者分别为100．0％、97．1％和97．1％,扩大野组患者分别为100．0％、100．0％和95．8％,两组生存率差异无统计学意义（P=0．86）。受累野组1、2、3年无进展生存率分别为97．6％、94．8％和91．7％,扩大野组分别为97．8％、93．2％和93．2％,两组无进展生存率差异无统计学意义（P=0．65）。发生Ⅰ度和Ⅱ度白细胞减少症者,受累野组3例（7．2％）,扩大野组9例（19．5％,P=0．089）。结论 Ⅰ、Ⅱ期HD患者进行综合治疗时,采用受累野照射可获得与扩大野照射相同的疗效,且能减少并发症的发生。     

Treatment of Early Stage Hodgkin's Disease According to Risk Factors

Between January 1981 and December 1987, 95 patients with stage IA (34 patients), IIA (42 patients) and stage IIB (19 patients) Hodgkin's disease (HD) were evaluated in our institution. Thirty patients defined as “high risk” because of either bulky mediastinal disease, systemic symptoms or both were treated with combined modality therapy (CMT). The remaining 65 patients considered as “standard risk” because they presented at diagnosis without any known adverse prognostic factor, received radiotherapy (RT) only. The median follow-up was 39 months. The complete remission (CR) rate was 97% (92/95). The actuarial 3 year overall (OS) and disease free survival (DFS) were 93% and 72% respectively with no differences between the two groups of patients. All 65 “standard risk” patients achieved CR; thirteen (20%) relapsed after a median time of 22 months. Twenty seven of 30 “high risk” patients (90%) achieved CR and six of them (22%) had early relapses.

No severe pancytopenia episodes or life-threatening complications occurred during therapy. As far as the risk of second neoplasms is concerned, we observed only a single case of acute non lymphoblastic leukemia 48 months after the completion of CMT. These results indicate that in unfavourable early stage HD, CMT is effective with a probability of more than a 70% DFS 3 years after therapy with an acceptable acute and late toxicity. Patients without “high” risk factors showed the expected response after RT. About 60% of the patients who failed RT could be salvaged by chemotherapy (CT) while refractory cases or patients who relapsed after CMT did poorly with a third line chemotherapeutic regimen. Therefore alternative therapeutic approaches including high dose CT followed by autologous bone marrow transplantation should be considered for this subset of patients.     

早期经典型霍奇金淋巴瘤的治疗进展

由于诊疗手段的不断改进,霍奇金淋巴瘤已成为治愈率较高的恶性肿瘤。但随着患者生存期的延长,治疗的远期不良反应越来越受到临床医生的关注。因此,根据疾病分期和危险因素对患者实施个体化治疗是目前霍奇金淋巴瘤的研究热点。本文综述了近年来早期经典型霍奇金淋巴瘤在个体化治疗方面的研究进展。     

Long-term results of a prospective trial of mantle irradiation alone for early-stage Hodgkin's disease.

BACKGROUND: To determine the long-term treatment outcome and late effects of mantle irradiation alone in selected patients with early-stage Hodgkin's disease. METHODS: Between 1988 and 2000, 87 patients with pathologic stage (Ann Arbor) I-IIA or clinical stage IA Hodgkin's disease were entered on to a prospective trial of mantle irradiation alone. Patients with B symptoms, large mediastinal adenopathy, or subcarinal or hilar involvement were excluded. The median doses to the mantle field and mediastinum were 36 Gy (range 30.3-40) and 38.6 Gy (range 30.6-44), respectively. The actuarial freedom from treatment failure (FFTF) and overall survival (OS) rates were calculated using the Kaplan-Meier technique. RESULTS: The median follow-up was 107 months (range 23-192). Thirteen of 87 patients (15%) relapsed at a median of 30 months (range 5-62). The 5- and 10-year actuarial FFTF rates were 86% and 84.7%, respectively. All 13 patients who relapsed are alive without evidence of disease at a median of 84 months (range 30-156) post-salvage therapy. Five patients developed a second malignancy at a median of 93 months (range 27-131). The 10-year actuarial risk of a second malignancy was 4.5%. There have been two deaths to date, both due to second malignancies. The 10-year OS rate was 98.2%. CONCLUSION: In selected patients with early-stage Hodgkin's disease, mantle irradiation alone has an excellent long-term survival rate, comparing favorably with the previous standard treatment of extended-field radiation therapy and the current standard of combined modality therapy.     

PACE BOM chemotherapy: A 12-week regimen for advanced Hodgkin's disease

Background: This study was designed to evaluate the efficacy andtoxicity of a 12-week alternating weekly chemotherapy regimen for advancedHodgkin's disease. Consolidative irradiation of residual masses was used inselected cases.Patients and methods: Eighty-three patients with newly diagnosedadvanced Hodgkin's disease (bulky stage IIA, stage IIB–IVB) or withprogressive disease after extended field radiotherapy for early stage diseasewere included in this study. The patients were treated for 12 weeks with PACEBOM comprising oral prednisolone together with intravenous doxorubicin,cyclophosphamide and etoposide alternating weekly with intravenous bleomycin,vincristine and methotrexate. Limited field adjuvant radiotherapy was alsogiven to 21 patients with localised persistent radiological abnormalitiesvisible on chest X-ray after chemotherapy. The study end points were overallsurvival, failure free survival (FFS) and toxicity, particularly with respectto reproductive function.Results: With a median post treatment follow up of 52 months theactuarial 5-year overall survival is 90% (confidence interval81%–95%) and FFS is 64%(52%–74%). This treatment was well tolerated and fertilitywas maintained in a high proportion of young adults.Conclusions: The brief duration PACE BOM regimen with or withoutradiotherapy appears to be comparable in efficacy to other doxorubicincontaining regimens, with a favourable toxicity profile. Randomised clinicaltrials are now needed to evaluate the role of this and comparable initialtreatment approaches to advanced Hodgkin's disease.     

Hodgkin's Disease: The Next Decade

Although treatment of Hodgkin's disease has been extensively studied in the past, fewer clinical studies are being reported, despite the fact that the optimal therapy for each stage has not yet been established. The pathologic subtypes have not been officially changed for years, although lymphocyte-predominant disease may be unrelated to the other subtypes, lymphocyte depleted histology may really be a T-cell large-cell lymphoma, mixed cellularity represents a spectrum of disease, and some cases remain unclassifiable. Staging has also still not been completely standardized, mainly because of reliance on the lymphangiogram and the staging laparotomy, which are being less commonly performed for treatment planning. Investigators still question the value of the gallium scan, magnetic resonance imaging, and abdominal ultrasound for treatment planning, and the role of these tests in the era of managed care is not defined. Finally, because treatment for the disease is so effective, the merit of each treatment plan may eventually be weighed in terms of emotional, social, and financial costs to the patient. For patients with early-stage (I-II) disease, only limited toxicity is acceptable; for patients with bulky stage II or stage III disease, combined modality therapy must be considered standard therapy, but investigators must find ways to lessen toxicity of radiotherapy and intensive chemotherapy. Finally, for patients with stage IV disease, ongoing studies of patients at high risk of relapse may reveal which will benefit from bone marrow or peripheral stem-cell transplantation as initial therapy.     

Treatment Options for Hodgkin's Disease During Pregnancy

Treatment results of 47 pregnant women with Hodgkin's disease (HD) are analyzed using data reported in the literature since 1960. Twenty-three of the patients were treated with radiation during pregnancy and 17 of the 23 patients (74%) were reported to be long term disease-free survivors. All of these pregnancies resulted in normal deliveries and the babies were evaluated to have no abnormalities at birth. Termination of pregnancy was performed in 12 patients and 10 (83%) of them survived with no evidence of disease after subsequent treatment. In 12 patients, the treatment was initiated only after delivery and 9 (75%) of the 12 patients are disease-free survivors. The characteristics of the patients as well as an analysis of the results according to treatment approach practiced in each trimester of pregnancy are reported. The radiation dose to the fetus is evaluated and the factors affecting the dose are analyzed

Experience with administering chemotherapy for HD during pregnancy is also reviewed. Twenty-six patients were treated during the first trimester. The patients treated with procarbazine, chlorambucil, cyclophosphamide or combination chemotherapy in the first trimester had abortions or malformed babies. When vinblastine was used during the first trimester in 13 patients, and nitrogen mustard in 3 patients, each of the 16 patients were reported to have delivered normal babies. When chemotherapy was used during the second or third trimesters, no abnormalities of the newborns were reported

This review suggests that the cure rate of HD is unlikely to be compromised in pregnancy in spite of the fact that radiation or chemotherapy had to be modified in order to conserve the fetus. The treatment alternatives in each trimester are discussed and the consequences of administering radiation or chemotherapy during pregnancy are reviewed     

Ten-year results of a strategy combining three cycles of ABVD and high-dose extended irradiation for treating Hodgkin's disease at advanced stages

Background: The treatment of Hodgkin's disease (HD) at advanced stages relies mainly upon multi-agent chemotherapies (CT), while the role of radiation therapy has not been definitely identified. The aim of this report is to analyze the 10-year results of a prospective study including 133 patients with HD clinical stages (CS) IIIA to IVB treated by three monthly courses of ABVD (adriamycin, bleomycin, vinblastin, and dacarbazine) followed by high-dose subtotal or total lymphoid irradiation [(S)TLI].Patients and methods: From 1 October 1981 to 30 September 1988, 133 adult patients with HD CS IIIA (45), IIIB (33), IVA (seven) and IVB (48) were entered in the non-randomized multicentric prospective trial POF81/34. The number of involved nodal areas (NINA), and the number of visceral sites (NVIS) involved were registered in all patients; patients with bulky mediastinal tumor (BuMT) (mediastinal mass ratio 0.45) were also identified. All patients received three monthly cycles of ABVD. Patients in complete remission (CR) or partial remission (PR) after completion of CT received a (S)TLI including the spleen (involved sites 40 Gy, non-involved 30 Gy); initially involved lung(s) and liver received 18 and 20 Gy, respectively; and patients not in CR or PR after CT or RT received salvage treatments. Univariate and multivariate analyses were performed to identify the factors contributing significantly to the prognosis; initial characteristics, as well as status after the three cycles of CT, were entered in the model.Results: Of the 133 patients, 74 (55.6%) entered in CR after CT and 116 (87.2%) after completion of radiation therapy. Ten-year freedom from progression (FFP), freedom from tumor mortality (FFTM) and survival rates were 70.4%, 78.9% and 70.6%, respectively. According to univariate analysis the NVIS ( one vs. two) was the only initial factor simultaneously influencing 10-year FFP (73.9% vs. 38.2%) FFTM (82.5 vs. 34.1%) and survival (73.5% vs. 17.3%) rates; on the other hand, the NINA ( four vs. five) influenced FFP (81.4% vs. 60.7%) and FFTM rates (87.3% vs. 71.4%) while symptoms (A vs. B) influenced FFP (80.7% vs. 63.3%) and survival (82.8% vs. 61.2%) rates. Finally, age (<40 vs. 40) influenced survival rate only (79.2% vs. 50%). According to multivariate analysis, NVIS and NINA had an independent impact on FFP and FFTM, while survival was modified by the NVIS and age. The post-CT status (CR vs. no CR) had a major impact on FFP (85.3% vs. 64.9%) FFTM (92.1% vs. 63.3%) as well as on survival (78.6% vs. 54.7%) rates in both univariate and multivariate analyses. Complications of therapy were mainly due to RT: 11 patients acquired second malignancies, six developed lung fibrosis or severe pulmonary infections, three developed intestinal obstructions and six developed angina pectoris or carotid stenosis.Conclusions: Tumor burden (identified by the number of involved nodal areas and the number of visceral sites) and the response to initial CT were the two independent factors influencing the outcome of this group of 133 patients with HD, CSIII and IV treated by three cycles of ABVD followed by high-dose [(S)TLI].     

早期霍奇金淋巴瘤的综合治疗

霍奇金淋巴瘤(HL)已成为一种可以治愈的疾病,目前研究的重点在于不增加疾病死亡率的前提下,降低治疗引起的并发症.最近10～15年,开展了Ⅰ～Ⅱ期HL综合治疗的系列随机研究,比较综合治疗和单纯放疗或单纯化疗的疗效,并研究综合治疗时的最佳化疗方案和化疗周期数、照射靶区大小和照射剂量.综合治疗和单纯放疗或单纯化疗比较,显著改善了早期HL无病生存率10%～15%,但未提高总生存率.预后好:早期HL行单纯放疗或2～4周期ABVD方案化疗加受累野照射;预后不良:早期HL行4～6周期ABVD化疗加受累野照射.     

ESHAP is an active regimen for relapsing Hodgkin's disease

Background: Refractory or relapsing Hodgkin's disease is associated with a poor prognosis. There is no widely accepted salvage chemotherapy regimen for these patients. However, the addition of high-dose chemotherapy followed by autologous hematopoietic transplantation (AHT) has proven of benefit to them. A prospective clinical trial was carried out to evaluate the efficacy and toxicity of ESHAP (etoposide, methylprednisolone, high-dose cytarabine, and cisplatin).Patients and methods: Twenty-two patients with refractory (5) or relapsing Hodgkin's disease (17) were entered and scheduled to receive three courses of ESHAP. Patients suitable for AHT were then given high-dose chemotherapy with CBV (cyclophosphamide, carmustine, and etoposide) plus AHT, whereas responding, non-AHT-suitable patients completed six ESHAP courses.Results: Nine patients achieved complete responses and seven partial responses (overall response rate 73%) with ESHAP. Grade 3–4 myelotoxicity was seen in 13 patients (59%). Nine patients received CBV plus AHT. At a median follow-up time of 50 months (range 6–96), seven patients (32%) are alive and disease-free. Three patients died of toxic effects of ESHAP (1) or CBV (2). Actuarial overall survival and disease-free survival were 35% and 27% at three years.Conclusions: ESHAP is an active regimen for relapsing Hodgkin's disease, with myelosuppression as its dose-limiting toxicity. An increased risk of treatment-related mortality when it is combined with high-dose chemotherapy can not be ruled out.     

Pregnancy after treatment of secondary acute promyelocytic leukemia following Hodgkin's disease: a case report

The authors report a case of therapy-related acute promyelocytic leukemia (t-APL), with typical cytogenetic translocation t(15;17), which appeared following chemotherapy (ABVD), and radiotherapy for Hodgkin's disease (IIB). After treatment with all-trans retinoic acid (Vesanoid(R) 45 mg/m2 daily) complete remission of t-APL was achieved. Then only one course of chemotherapy '3+7' (doxorubicin 45 mg/m2 1-3 d, cytosar 200 mg/m2 1-7d) was applied and the patient interrupted further treatment in July 1994. Four years later she had a normal pregnancy and delivered a healthy female infant in December 1998.