论文部分内容阅读
目的 探讨成人早期 (Ⅰ、Ⅱ期 )霍奇金病 (HD)放射治疗野的规范使用。方法 回顾性分析 1984年 1月至 1997年 12月中国医学科学院肿瘤医院收治的 2 0 6例初治的膈上型早期霍奇金病成人患者 (≥ 15岁 ) ,其中 130例行单纯放射治疗 (称为单放组 ) ,76例行放射治疗 +化疗 (称为综合治疗组 )。放射治疗采用累及野 (IF)照射 7例、斗篷野 (MF)照射 34例、次全淋巴结照射 (STNI) 140例、全淋巴结照射 (TNI) 2 5例。Kaplan Meier法行生存分析、Logrank法行显著性检验。结果 ①全组 5、10年总生存率分别为 85 .1%和 73.2 % ,5、10年无瘤生存率分别为 6 8.0 %和 6 3.6 %。②单放组中接受MF、STNI和TNI照射的 5年生存率分别为 6 9.2 %、93.3%和 94.4% ;5年无瘤生存率分别为 5 4.2 %、79 .2 %和 79.9% (P <0 .0 5 )。③综合治疗组中接受IF(MF)照射和STNI(TNI)的 5年总生存率分别为75 .7%和 90 .6 % ,5年无瘤生存率分别为 43.1%和 73.3% (P <0 .0 5 )。结论 除了少数预后极好的ⅠA 期患者可给予单纯MF照射外 ,其它期别的患者在采用单纯放射治疗时宜选用STNI,盲目缩小放射治疗野将会导致无瘤生存率甚至总生存率的下降。预后不利的患者应给予放射治疗 +化疗综合治疗。
Objective To investigate the use of radiotherapy field for early adult (I, II) Hodgkin’s disease (HD). Methods A retrospective analysis of 206 adult patients (≥15 years old) with early supracondylar Hodgkin’s disease admitted to the Chinese Academy of Medical Sciences Cancer Hospital from January 1984 to December 1997 was performed. Of these, 130 patients were treated with radiotherapy alone. (referred to as single-release group), 76 patients underwent radiotherapy + chemotherapy (called comprehensive treatment group). Radiation therapy included 7 cases with Infrared (IF) irradiation, 34 cases with MF irradiation, 140 cases with sub-lymph node irradiation (STNI), and 25 cases with total lymph node irradiation (TNI). Kaplan Meier method survival analysis, Logrank test significance. Results 1 The overall 5-year and 10-year survival rates for the whole group were 85.1% and 73.2%, respectively. The 5-year and 10-year disease-free survival rates were 68.0 % and 6 3.6 %, respectively. 2 The 5-year survival rates of MF, STNI, and TNI irradiation in the radiotherapy group were 69.2%, 93.3%, and 94.4%, respectively; the 5-year disease-free survival rates were 54.2%, 79.2%, and 79.9%, respectively. <0 .0 5 ). 3 The 5-year overall survival rates of IF (MF) irradiation and STNI (TNI) in the comprehensive treatment group were 75.7% and 90.6 %, respectively, and the 5-year disease-free survival rates were 43.1% and 73.3%, respectively (P < 0 .0 5 ). Conclusions In addition to a few IA patients with excellent prognosis who can be given MF irradiation alone, STNI should be used when other radiation therapy is used in other patients. Blindly reducing the radiation treatment field will lead to a reduction in disease-free survival or even overall survival. Patients with unfavorable prognosis should be given radiation therapy + comprehensive chemotherapy.