150例早期霍奇金淋巴瘤的综合治疗

目的 对比单纯化疗、单纯放疗与综合治疗对早期霍奇金淋巴瘤(HL)的疗效.方法 回顾性分析150例Ⅰ期或Ⅱ期(早期)HL患者的临床资料,按照初次治疗方式分为单纯化疗组(22例)、单纯放疗组(18例)、化疗联合放疗的综合治疗组(109例)和手术组(1例).化疗方案以ABVD和MOPP为主,放疗方式主要包括受累野放疗、扩大野放疗和次全淋巴结照射.结果 结节硬化型、混合细胞型、淋巴细胞为主型、淋巴细胞消减型和结节性淋巴细胞为主型HL分别为84、39、23、3和1例.全组有72例患者资料完整,可判断预后,其中以欧洲癌症研究和治疗组织及德国霍奇金淋巴瘤研究组标准判断为0分者分别占36.1%和29.2%.全组完全缓解33例,部分缓解109例,疾病稳定5例,疾病进展3例.全组中位随访71.5个月,6年治疗失败率为18.8%,7年总生存率为89.3%.单因素分析显示,综合治疗的疗效显著优于单纯化疗,结节硬化型和混合细胞型的治疗失败风险明显低于淋巴细胞为主型(均P＜0.05).多因素分析显示,治疗方式可以显著影响预后,单纯化疗发生治疗失败的风险是综合治疗的2.52倍(P=0.004).单因素和多因素分析均未发现总生存时间的影响因素.综合治疗组的急性不良反应发生率较单纯化疗组或单纯放疗组高,主要表现为白细胞减低、胃肠道反应和脱发.结论 对于早期HL,综合治疗可降低治疗失败风险,但不良反应较重.

Combined-modality therapy for 150 cases of early-stage Hodgkin's lymphoma

Objective To compare the efficacy of chemotherapy alone,radiotherapy alone and combined-modality therapy in the treatment for early-stage Hodgkin's lymphoma(HL).Methods From 1999 to 2002.totally 150 patients with stage Ⅰ or Ⅱ HL were treated in our hospital.They were stratified into several groups based on initial treatment strategy:chemotherapy alone(CT group,n=22),radiotherapy alone(RT group,n=18),combined-modality therapy(CMT group,n=109)and surgical resection(SR group,n=1).Chemotherapy regimens were mainly ABVD(adriamycin,bleomycin,vinblastine and dacarbazine)and MOPP(mechlorethamine,vincristine.procarbazine and prednisone).Radiotherapy modes included involved field radiotherapy(IFRT),extended field radiotherapy(EFRT)and sub-total nodal irradiation(STNI).Results The pathological types included nodular sclerosis(NS,n=84),mixed-cellularity(MC,n=39),lymphocyte-predominant(LP,n=23),lymphocyte-depleted(LD,n=3)and nodular lymphocyte predominant Hodgkin's disease(NLPHD,n=1).Of those,72 were evaluble in terms of prognostic factors.No poor prognostic factor was found in 36.1%or 29.2%of the patients according to EORTC or GHSG criteria,respectively.There were 33 patients with complete response (CR),109 with partial response(PR),5 with stable disease(SD)and 3 with progressive disease(PD)after initial therapy.The median follow-up period was 71.5 months.The overall 7-yr survival rate was 89.3%,and treatment failure rate at 6 years was 18.8%.The response rate of CMT group was superior to that of CT group,and the patients with nodular sclerosis or mixed-cellularity type had significandy lower risk of treatment failure(P=0.009 and 0.019,respectively).,The multivariate analysis revealed that the treatment strategies affected the prognosis significantly.The risk of failure of chemotherapy alone was 2.52 times higher than that of combined-modality therapy(P=0.004).No predictive factor affecting OS was identified by either univariate or multivariate analysis.The patients in CMT group suffered more adverse effects than those in either CT or RT groups,which mainly consisted of leucopenia,alopecia and gastrointestinal symptoms.Conclusion Combined-medality therapy is more effective than chemotherapy alone or radiotherapy alone in the treatment for early stage Hodgkin's lymphoma.Tho,gh its acute adverse affects are more severe than that of chemotherapy or radiotherapy alone,it may reduce the risk of Lreatment failure.