Louw G, Pinkerton C R
Postgraduate Medical School, Brighton University, Westlain House, Falmer, East Sussex, UK, BN1 9PH.
Cochrane Database Syst Rev. 2002(3):CD002035. doi: 10.1002/14651858.CD002035.
Hodgkin's disease is one of the most curable cancers in children, particularly at the early stages. However it is not clear which combinations of treatment strategies are most effective at maintaining high cure rates and minimising long term harmful effects or sequelae of treatment.
To assess the effects of radiotherapy, chemotherapy or combined radiotherapy and chemotherapy on relapse free survival and overall survival rates in children with early (stage I to IIA) Hodgkin's disease.
We searched the Cochrane Library (issue 4, 2001), MEDLINE (1966 to July 2001), EMBASE, Cinahl, Cancer-CD and reference lists of relevant articles. We also handsearched six journals.
Randomised controlled trials of involved field radiotherapy, extended field radiotherapy, anthracycline based chemotherapy regimens, or alkylating chemotherapy agents in children to 19 years of age with Hodgkin's disease.
Trial eligibility and quality were assessed and study authors were contacted for additional information.
Four trials involving 334 children were included. It was not possible to combine the outcomes as they covered different treatment regimens. The trials were of variable quality. One trial comparing radiotherapy alone showed no discernible difference in relapse free survival (relative risk 0.73, 95% confidence interval 0.49 to 1.09) or overall survival (relative risk 0.92, 95% confidence interval 0.79 to 1.07) between involved field and extended field radiotherapy. No discernible difference was found between involved field radiotherapy plus chemotherapy and extended field radiotherapy and chemotherapy (based on one small trial). In another trial, involved field radiotherapy plus chemotherapy appeared to increase relapse free survival compared to either involved field or extended field radiotherapy alone, although a discernible difference was found for overall survival. Extended field radiotherapy alone appeared to increase relapse free survival compared to extended radiotherapy plus chemotherapy (relative risk 0.34, 95% confidence interval 0.14 to 0.83) but no discernible difference was apparent for overall survival (based on one trial).
REVIEWER'S CONCLUSIONS: There is little evidence from randomised controlled trials to evaluate the consensus approach of short course chemotherapy and local radiotherapy, although no discernible difference in survival was detected between involved field and extended field radiotherapy in one randomised trial.
霍奇金淋巴瘤是儿童最可治愈的癌症之一，尤其是在早期阶段。然而，尚不清楚哪种治疗策略组合在维持高治愈率以及将治疗的长期有害影响或后遗症降至最低方面最为有效。
评估放射治疗、化学治疗或联合放射治疗与化学治疗对早期（I至IIA期）霍奇金淋巴瘤患儿无复发生存率和总生存率的影响。
我们检索了Cochrane图书馆（2001年第4期）、MEDLINE（1966年至2001年7月）、EMBASE、Cinahl、Cancer-CD以及相关文章的参考文献列表。我们还手工检索了六种期刊。
针对19岁及以下患有霍奇金淋巴瘤的儿童，进行受累野放射治疗、扩大野放射治疗、基于蒽环类药物的化疗方案或烷化剂化疗药物的随机对照试验。
评估试验的入选资格和质量，并联系研究作者获取更多信息。
纳入了四项涉及334名儿童的试验。由于试验涵盖不同的治疗方案，因此无法合并结果。这些试验质量参差不齐。一项比较单纯放射治疗的试验显示，受累野放射治疗和扩大野放射治疗在无复发生存率（相对风险0.73，95%置信区间0.49至1.09）或总生存率（相对风险0.92，95%置信区间0.79至1.07）方面无明显差异。在受累野放射治疗加化疗与扩大野放射治疗及化疗之间未发现明显差异（基于一项小型试验）。在另一项试验中，与单独的受累野或扩大野放射治疗相比，受累野放射治疗加化疗似乎增加了无复发生存率，尽管在总生存率方面发现有明显差异。与扩大野放射治疗加化疗相比，单纯扩大野放射治疗似乎增加了无复发生存率（相对风险0.34，95%置信区间0.14至0.83），但在总生存率方面未发现明显差异（基于一项试验）。
随机对照试验几乎没有证据来评估短程化疗和局部放射治疗的共识方法，尽管在一项随机试验中受累野放射治疗和扩大野放射治疗在生存率方面未发现明显差异。
