For patients with Morbus Hodgkin and CS I/II of the low risk group and primary radiotherapy recommended treatment fields are: regional field for isolated high cervical involvement, mantle field for isolated mediastinal involvement and extended mantle field for the other patients. Omission of the infradiaphragmatic irradiation volume for PS I/II may be regarded as an advantage, which must be compared with the risk of a staging laparotomy, whereas the low risk of undertreatment of a small part of patients with CS I/II PS III probably does not outweigh the risk of the laparotomy. Equal efficacy of chemotherapy alone for these patients has not been proven sufficiently and important questions concerning long-term risks are unanswered. Ongoing studies will show, whether combinations with reduced chemotherapy or other types of chemotherapy and local radiotherapy are superior. Details of the mantle field borders and blocking are described. In most patients with adjuvant radiotherapy after complete remission after chemotherapy, the recommended target volume includes only the regions with proven involvement before chemotherapy. Details of the mediastinal treatment volume for patients with adjuvant radiotherapy after chemotherapy for bulky mediastinal disease are given. According to some recent analysis of a large body of dose-effect data, the recommended target doses in primary irradiation are between 36 and 40 Gy for regions with proven involvement and between 30 and 36 Gy for electively treated regions. The recommended target dose per fraction is between 1.5 and 1.8 Gy and less than 2 Gy in various critical tissues. According to the recent recommendations, the maximal total doses in mantle field radiotherapy to the spinal cord should be 38 Gy for radiotherapy alone and 36 Gy for radiotherapy combined with chemotherapy. The maximal total dose to the whole heart should be 15 Gy and for the other parts between 30 and 35 Gy. After chemotherapy with MOPP oder MOPP-like regimes, there is a cumulative risk of leukaemia between 2.2 and 11.9%. After radiotherapy alone, there is only a very low risk of leukaemia after radiotherapy and chemotherapy to the risk after chemotherapy. Most long-term studies show an increased risk of solid second malignancies associated with radiotherapy with a relative risk of approximately two. In the analyzed studies, the cumulative risk of solid second malignancy after seven to 15 years is between 7 and 11.2% after radiotherapy, between 7 and 11.7% after chemotherapy and between 7 and 11.7% after radiotherapy and chemotherapy.(ABSTRACT TRUNCATED AT 400 WORDS)

译文

对于低危组和初级放疗的Morbus Hodgkin和CS I/II患者,推荐的治疗领域是: 孤立的高宫颈受累的区域领域,孤立的纵隔受累的外罩领域和其他患者的外罩领域。省略PS I/II的diaphragm肌下辐射量可能是一个优势,必须将其与分期剖腹手术的风险进行比较,而一小部分CS I/II PS III的患者治疗不足的风险较低可能不会超过剖腹手术的风险。仅化疗对这些患者的同等疗效尚未得到充分证明,有关长期风险的重要问题尚未得到解答。正在进行的研究将表明,减少化疗或其他类型的化疗和局部放疗的组合是否更好。描述了地幔场边界和阻塞的详细信息。在大多数化疗后完全缓解后进行辅助放疗的患者中,推荐的目标体积仅包括化疗前已证实受累的区域。详细介绍了大纵隔疾病化疗后辅助放疗患者的纵隔治疗量。根据对大量剂量效应数据的最新分析,对于已证实受累的区域,主要照射的推荐目标剂量在36至40 Gy之间,而对于选择性治疗的区域,建议的目标剂量在30至36 Gy之间。每部分推荐的目标剂量在1.5至1.8 Gy之间,并且在各种关键组织中小于2 Gy。根据最近的建议,套膜场放疗对脊髓的最大总剂量应为单纯放疗38 Gy,放疗联合化疗36 Gy。整个心脏的最大总剂量应为15 Gy,其他部分应为30至35 Gy。用MOPP或MOPP样方案化疗后,在2.2和11.9% 之间存在白血病的累积风险。单独放疗后,只有放疗和化疗后的白血病风险极低。大多数长期研究表明,与放疗相关的实体第二恶性肿瘤的风险增加,相对风险约为2。在分析的研究中,7至15年后发生实体第二恶性肿瘤的累积风险在放疗后7至11.2% 之间,化疗后7至11.7% 之间,放疗和化疗后7至11.7% 之间。(摘要截断在400字)

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