Zusammenfassung
Basierend auf der Stadieneinteilung nach Ann Arbor und dem Vorliegen klinischer Risikofaktoren werden Hodgkin-Patienten in frühe („early favourable“), mittlere („early unfavourable“) und fortgeschrittene Stadien eingeteilt. Die Kombination aus Chemotherapie und nachfolgender Bestrahlung gilt als Standardbehandlung für Patienten in frühen Stadien. In der HD10-Studie konnte belegt werden, dass eine Therapie mit 2 Zyklen ABVD auch dann ausreicht, wenn zusätzlich nur 20 Gy im wesentlich kleineren „involved field“ (IF) bestrahlt werden. Diese Therapie gilt als neuer Goldstandard für die Behandlung von Hodgkin-Patienten in frühen Stadien. Für Patienten in mittleren Stadien ist ebenfalls die kombinierte Behandlung, bestehend aus 4 Zyklen Chemotherapie und einer Bestrahlung im „involved field“, Standard. In fortgeschrittenen Stadien gab es lange Zeit keine weitere Verbesserung der Therapieergebnisse. Dieser Stillstand wurde durch Einführung von BEACOPPeskaliert überwunden.
Zahlreiche kleinere, nichtrandomisierte Studien deuten den besonderen prognostischen Wert der Positronenemissionstomographie (PET) bei Patienten mit Hodgkin-Lymphomen an. Die Behandlung rezidivierter Patienten nach Hochdosischemotherapie sollte innerhalb klinischer Studien erfolgen.
Abstract
Based on the Ann Arbor stage classification and the presence of clinical risk factors, patients with Hodgkin’s lymphoma are classified as early (early favorable), intermediate (early unfavorable) and advanced stages. The combination of chemotherapy and subsequent radiation is the standard treatment for patients in early stages. In the HD10 study it could be shown that treatment with 2 cycles of ABVD is also sufficient when only 20 Gy radiation is additionally applied in the substantially smaller involved field (IF). This therapy is the new gold standard for patients with early stage Hodgkin’s lymphoma. For patients with intermediate stages combined treatment consisting of 4 cycles of chemotherapy and involved field radiation is the current standard. In advanced stages there has been no further improvement of treatment results for a long time. This deadlock was broken by the introduction of BEACOPPeskaliert .
Many small non-randomized studies have indicated the special prognostic value of PET for patients with Hodgkin’s lymphoma. Treatment of patients with recurrent disease after high-dose chemotherapy should be carried out within clinical studies.
Literatur
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Engert, A. Aktuelle Therapiestrategien der Deutschen Hodgkin Studiengruppe (GHSG). Onkologe 16, 28–34 (2010). https://doi.org/10.1007/s00761-009-1769-y
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DOI: https://doi.org/10.1007/s00761-009-1769-y