Balwierz W, Moryl-Bujakowska A, Depowska T, Klekawka T, Rokicka-Milewska R, Sopylo B, Kolakowska-Mrozowska B, Chybicka A, Boguslawska-Jaworska J, Pisarek J, Ras M, Sonta-Jakimczyk D, Janik-Moszant A, Kolecki P, Kaczmarek-Kanold M, Kowalczyk J, Odoj T, Matysiak M, Newecka-Samol T, Balcerska A, Adamkiewicz-Drozynska E, Wysocki M, Kurylak A
Klinika Hematologii i Onkologii Dzieciecej, Polsko-Amerykanski Instytut Pediatrii Collegium Medicum, Uniwersytet Jagielonski, Wielicka 265, 30-663 Krakow, Poland.
Med Wieku Rozwoj. 2001 Jul-Sep;5(3 Suppl 1):25-35.
Between 1997 to 1999 in 9 centres of the Polish Paediatlic Leukemia/Lymphoma Study Group, 167 children and adolescents (aged 2-19 years) with stage 1 to IV Hodgkin's disease (HD) were treated according to a regimen with a limited use of radiotherapy (RT). All patients received B-DOPA and MVPP chemotherapy. The number of cycles of chemotherapy was adjusted in respective risk groups. In 13 children with stage IA and IIA disease with favourable prognostic factors chemotherapy alone was used. In other patients the dose of RT applied to lymphatic regions was 15-46,4 Gy. In case of a small tumour at presentation and good response to initial chemotherapy the RT dose was 15-16 Gy. In other cases doses of 25-30 Gy were planned. The use of higher doses, particularly exceeding 35 Gy, in eleven patients, was not justified. Among all the 167 patients, three oftliem (1.2%) with advanced disease (Stage III-1V) did not achieve first remission. The 4-year overall survival (OS), relapse free survival (RFS) and event free survival (EPS) were 99%. 93% and 90%, respectively. Relapses occurred in 8 children (first remission lasted for 4-29 (median = 9 months). All 13 children in whom chemotherapy alone was used remain in first remission. In the group of children who received RT in the dose of 15-16 Gy relapse occurred in one child. Our preliminary analysis indicates that limited use of RT in selected cases of HD in children and adolescents did not show worse results of treatment. However, the assessment of possible influence of this regimen on the decreased rate of late complications requires longer follow-up.
1997年至1999年间，波兰儿童白血病/淋巴瘤研究组的9个中心，167名2至19岁患有I至IV期霍奇金病（HD）的儿童和青少年按照放疗（RT）使用受限的方案接受治疗。所有患者均接受B-DOPA和MVPP化疗。化疗周期数在各个风险组中进行调整。13例具有良好预后因素的IA期和IIA期疾病患儿仅接受化疗。其他患者应用于淋巴区域的放疗剂量为15 - 46.4 Gy。对于初诊时肿瘤较小且对初始化疗反应良好的患者，放疗剂量为15 - 16 Gy。在其他情况下，计划剂量为25 - 30 Gy。11名患者使用更高剂量，特别是超过35 Gy的剂量是不合理的。在所有167例患者中，3例（1.2%）晚期疾病（III - IV期）患者未获得首次缓解。4年总生存率（OS）、无复发生存率（RFS）和无事件生存率（EPS）分别为99%、93%和90%。8名儿童出现复发（首次缓解持续4 - 29个月（中位数 = 9个月））。仅接受化疗的13名儿童均保持首次缓解。在接受15 - 16 Gy放疗剂量的儿童组中，有1名儿童出现复发。我们的初步分析表明，在儿童和青少年HD的选定病例中有限使用放疗并未显示出更差的治疗结果。然而，评估该方案对降低晚期并发症发生率的可能影响需要更长时间的随访。
