放射治疗期间的反应可能与纵隔霍奇金病的预后有关。

B Movsas, M C Barrows, S M Steinberg, L P Middleton, P Okunieff, E S Jaffe, A H Epstein
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引用次数: 5

摘要

已观察到化疗后淋巴瘤消退率与长期预后之间的关系。本研究旨在确定纵隔霍奇金病放射治疗期间肿瘤消退率是否预示着肿瘤复发。作为一项NCI随机试验的一部分,29名早期霍奇金病患者仅接受放射治疗,其疾病的非大规模纵隔成分和所有必要的模拟和端口片可用于分析。所有患者均为结节性硬化症。阶段分布如下:IA-1;IIA-17;IIB-8;IIIA1-3。中位年龄为27岁,中位辐射剂量为4470 cGy。通过将纵隔肿块的宽度除以隆突水平的胸内直径,从每位患者的模拟和每周端口片中计算出纵隔肿块的质量比。还进行了组织病理学相关性,以量化标本中肿瘤与硬化症的程度。使用单因素分析和Cox比例风险分析来研究几个协变量(分期、性别、症状、淋巴外疾病、初始纵隔质量比、年龄、剂量、标本中肿瘤百分比和肿瘤消退累积百分比)与现场复发时间以及任何失败的概率之间的关系。单变量分析表明,较低的剂量、较高的标本肿瘤百分比和较低的累积百分比回归是现场复发和任何失败的统计显著预测因子。通过Cox回归分析,累积百分比回归是唯一与现场复发独立相关的因素(双尾P=0.04)。标本中肿瘤的百分比是唯一与任何失败时间相似的因素(双尾P=0.02)。组织病理学相关性提示,早期纵隔何杰金氏病患者在标本中表现出高百分比的肿瘤可能会增加失败的风险。在放射治疗期间,低累积百分比消退的患者似乎在野内复发的风险增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Response during radiotherapy may be associated with outcome in mediastinal Hodgkin's disease.

A relationship between the rate of regression of lymphomas treated with chemotherapy and long-term outcome has been observed. This study was undertaken to determine if the rate of tumor regression during radiotherapy for mediastinal Hodgkin's disease is a predictor of in-field recurrence. Twenty-nine patients with early-stage Hodgkin's disease treated with radiotherapy alone as part of an NCI randomized trial had both a non-massive mediastinal component of disease and all requisite simulation and port films available for analysis. The histology was nodular sclerosis in all patients. Stage distribution was as follows: IA-1; IIA-17; IIB-8; IIIA1-3. The median age was 27 years and the median radiation dose was 4470 cGy. A mediastinal mass ratio was calculated from each patient's simulation and weekly port films by dividing the width of the mediastinal mass by the intrathoracic diameter at the level of the carina. Histopathologic correlation was also done to quantify the degree of tumor vs. sclerosis in the specimens. Univariate analysis and Cox proportional hazards analysis were used to study the association between several covariates (stage, sex, symptoms, extra-lymphatic disease, initial mediastinal mass ratio, age, dose, percent tumor in the specimen, and cumulative percentage of tumor regression) and time to in-field recurrence, as well as probability of any failure. Univariate analysis indicates that lower dose, higher percent tumor in the specimen, and lower cumulative percent regression are statistically significant predictors for in-field recurrence, as well as for any failure. By Cox regression analysis, cumulative percent regression is the sole factor independently associated with in-field recurrence (two-tailed P=0.04). The percent tumor in the specimen is the only factor similarly identified for time to any failure (two-tailed P=0.02). Histopathologic correlation suggests that patients with early stage mediastinal Hodgkin's disease who demonstrate a high percent tumor in the specimen may be at increased risk of failure. Patients with a low cumulative percent regression during radiotherapy appear to be at an increased risk of in-field recurrence.

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