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Aim. To increase the effi cacy of chemo-radiotherapy in patients with stage II Hodgkin’s lymphoma (HL) with supradiaphragmal lesions by diff erent fractionation (conventional fractionation [CF] and multi-fractionation [MF]) and various radiation volume (mantle radiotherapy, involved fi eld radiotherapy [IFRT] or involved site radiotherapy [ISRT]). Materials & Methods. The clinical trial included 317 patients with stage II classical HL with supradiaphragmal lesions who have received chemo-radiotherapy in AM Granov Russian Scientifi c Centre of Radiology and Surgery Technologies from 1986 to 2015 (n = 301) and in SM Berezin International Institute of Biological Systems from 2014 to 2016 (n = 16). The mean age was 30.9 years (ra nge 18–65); the study group included 107 men and 210 women. The diagnosis in all the cases was confi rmed by immunomorphologic analysis. The treatment program included 2 to 6 cycles of ABVD regimen followed by CF (n = 153) or MF (n = 148) radiation therapy. The patients received mantle radiotherapy or IFRT with the cumulative dose of 30 to 40 Gy (2D planning, 237 patients) or ISRT with the cumulative dose of 30 to 40 Gy (3D planning, n = 80, CF only). The MF-regimen was administered only with 2D planning, mantle radiotherapy and IFRT. The CF-regimen was administered with 2D-planning (n = 89) with the same volume of radiation and 3D planning using conformal RT (3D-CRT) as ISRT with the cumulative dose of 30 to 36 Gy (n = 80). From the total of 80 patients 16 patients were treated with beam intensity modulation (IMRT) and 64 patients were treated without IMRT. Results. The treatment response (both complete and partial remission) was reported in 235 (99.2 %) of 237 patients of 2D planning group. In 2 cases (0.8 %) a progression of disease was diagnosed. Out of 235 patients with remission 222 (94.5 %) had a complete remission and 13 (5.5 %) had a partial 71 ht tp : / /b lood journa l . ru / Конвенциональная и конформная лучевая терапия при ЛХ 19 (8,1 %) пациентов. Общая 5и 10-летняя выживаемость (ОВ) была одинаковой и составила 98,0 ± 1,4 %, а безрецидивная (БРВ) — 85,9 ± 1,3 %. У больных с ОФ 5и 10-летняя ОВ составила 97,8 ± 1,7 %, а БРВ на эти же сроки при стандартном режиме фракционирования — 85,0 ± 1,5 %, при МФ — 86,2 ± 1,6 % (p > 0,1). Общее число местных лучевых реакций в целом и лучевых пульмонитов в частности было значительно меньше при облучении 2 раза в день, чем при ОФ в условиях 2D-планирования и мантиевидного облучения. Уменьшение объема облучения с мантиевидного до IFRT также снижало число пульмонитов. Количество эзофагитов не различалось при разных режимах фракционирования и указанных объемах облучения. Результаты анализа подтверждают полное отсутствие лучевых перикардитов при двух видах конформной ЛТ: с IMRT и без таковой. Пульмониты также не наблюдались при IMRT, но были при 3D-КЛТ и 2D-ЛТ, их число было статистически значимо выше. Частота эзофагитов в группе КЛТ (n = 80) была почти в 2 раза ниже таковой при конвенциональной ЛТ (22,5 и 43,9 %; p < 0,01). Заключение. Снижение частоты непосредственных местных лучевых реакций является главным достоинством новых технологий, которые, несомненно, послужат основой профилактики серьезных поздних лучевых осложнений, влияющих на продолжительность и качество жизни больных ЛХ. Ключевые слова: лимфома Ходжкина, лучевая терапия, фракционирование, 2Dи 3D-планирование. Получено: 16 сентября 2017 г. Принято в печать: 5 декабря 2017 г. Для переписки: Николай Васильевич Ильин, д-р мед. наук, профессор, ул. Ленинградская, д. 70, пос. Песочный, Санкт-Петербург, Российская Федерация, 197758; тел.: +7(812)596-90-35; e-mail: ilyin_prof@mail.ru. Для цитирования: Виноградова Ю.Н., Иванова Е.И., Чумаченко А.И. и др. Конвенциональная и конформная лучевая терапия с модуляцией пучка по интенсивности и без таковой при лимфоме Ходжкина II стадии с поражениями выше диафрагмы. Клиническая онкогематология. 2018;11(1):70–7. DOI: 10.21320/2500-2139-2018-11-1-70-77 remission. Within the group treated with the conventional RT 19 (8.1 %) patients had recurrent disease. Overall 5and 10year survival (OS) was equal and accounted for 98.0 ± 1.4 %, the disease-free survival (DFS) was also equal between groups and accounted for 85.9 ± 1.3 %. The rate of 5and 10-year OS in patients who received CF was 97.8 ± 1.7 %; the DFS rate for the same period was 85.0 ± 1.5 % with standard fractionation and 86.2 ± 1.6 % with MF (p > 0.1). The total number of local radiation reactions and the number of radiation pulmonitis were signifi cantly smaller with the exposure twice daily compared to CF at 2D planning and mantle irradiation. Decreasing the radiation volume from the mantle type to IFRT was shown to reduce the incidence of pulmonitis. The incidence of esophagitis remained the same with diff erent fractionation and the irradiation volumes specifi ed above. The results of the analysis proved the total absence of radiation pericarditis with both types of conformal RT with or without IMRT. No pulmonitis cases were observed with IMRT; the use of 3D-CRT and 2D-RT signifi cantly increased the incidence of pulmonitis. The incidence of esophagitis within the CRT-group (n = 80) was 2 times lower compared to the conventional RT (22.5 % and 43.9 %; p < 0.01). Conclusion. The innovative technologies of radiation therapy allowed to reduce the incidence of early local radiation reactions. These technologies will be the basis for preventing severe late radiation complications that reduce the life expectancy and quality of life of patients with HL.

kliničeskaâ onkogematologiâ

Conventional and Conformai Radiotherapy with and without Beam Intensity Modulation in Patients with Stage II Hodgkin's Lymphoma with Supradiaphragmal Lesions