Hudson Melissa M, Krasin Matthew J, Kaste Sue C
Department of Hematology-Oncology, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105, USA.
Pediatr Radiol. 2004 Mar;34(3):190-8. doi: 10.1007/s00247-003-1114-3. Epub 2004 Jan 27.
Advances in diagnostic imaging technology, especially functional imaging modalities like positron emission tomography (PET), have significantly influenced the staging and treatment approaches used for pediatric Hodgkin's lymphoma. Today, the majority of children and adolescents diagnosed with Hodgkin's lymphoma will be cured following treatment with non-cross-resistant combination chemotherapy alone or in combination with low-dose, involved-field radiation. This success produced a greater appreciation of long-term complications related to radiation, chemotherapy, and surgical staging that prompted significant changes in staging and treatment protocols for children and adolescents with Hodgkin's lymphoma. Contemporary treatment for pediatric Hodgkin's lymphoma uses a risk-adapted approach that reduces the number of combination chemotherapy cycles and radiation treatment fields and doses for patients with localized favorable disease presentation. Advances in diagnostic imaging technology have played a critical role in the development of these risk-adapted treatment regimens. The introduction of computed tomography (CT) provided an accurate and non-invasive modality to define nodal involvement below the diaphragm that motivated the change from surgical to clinical staging. The introduction of functional imaging modalities, like positron emission tomography (PET) scanning, provided the means to correlate tumor activity with anatomic features generated by CT and modify treatment based on tumor response. For centers with access to this modality, PET imaging plays an important role in staging, evaluating tumor response, planning radiation treatment fields, and monitoring after completion of therapy for pediatric Hodgkin's lymphoma. This trend will likely increase in the future as a result of PET's superior sensitivity in correlating sites of tumor activity compared to other available functional imaging modalities. Ongoing prospective studies of PET in pediatric patients will increase understanding about the optimal use of this modality in children with cancer and define the characteristics of FDG-avid nonmalignant conditions that may be problematic in the interpretation of tumor activity.
诊断成像技术的进步，尤其是正电子发射断层扫描（PET）等功能成像方式，对小儿霍奇金淋巴瘤的分期和治疗方法产生了重大影响。如今，大多数被诊断为霍奇金淋巴瘤的儿童和青少年在接受非交叉耐药联合化疗单独治疗或联合低剂量受累野放疗后都能治愈。这一成功使人们更加认识到与放疗、化疗和手术分期相关的长期并发症，促使小儿霍奇金淋巴瘤患者的分期和治疗方案发生了重大变化。当代小儿霍奇金淋巴瘤的治疗采用风险适应性方法，减少了局限性有利疾病表现患者的联合化疗周期数以及放疗野和剂量。诊断成像技术的进步在这些风险适应性治疗方案的发展中发挥了关键作用。计算机断层扫描（CT）的引入提供了一种准确且无创的方式来确定膈肌以下的淋巴结受累情况，促使从手术分期转变为临床分期。功能成像方式如正电子发射断层扫描（PET）扫描的引入，提供了将肿瘤活性与CT生成的解剖特征相关联并根据肿瘤反应调整治疗的手段。对于能够使用这种方式的中心，PET成像在小儿霍奇金淋巴瘤的分期、评估肿瘤反应、规划放疗野以及治疗完成后的监测中发挥着重要作用。由于PET与其他可用功能成像方式相比在关联肿瘤活性部位方面具有更高的敏感性，这种趋势未来可能会增加。正在进行的小儿患者PET前瞻性研究将增进对这种方式在癌症患儿中最佳使用的理解，并确定在解释肿瘤活性时可能存在问题的FDG摄取非恶性情况的特征。
