Oliapuram Jose B, Koerner Paul, Bertolone Salvatore, Patel C C, Spanos William J, Paris Kristie J, Silverman Craig L, Yashar Catheryn M
Departments of Radiation Oncology and Pediatrics (Division of Pediatric Hematology and Oncology), James Graham Brown Cancer Center, University of Louisville School of Medicine, 529 South Jackson Street, Louisville, KY 40202, USA.
J Ky Med Assoc. 2004 Mar;102(3):104-6.
Thirty-two patients were treated in this Department from 1981-1992. The median age was 14 years (range 4 years to 17 years). There are 6 patients (19%) below the age of 10 years, 16 patients (50%) between 11 years to 15 years, and 10 patients (31%) above 16 years. Twenty-three patients (72%) are male and 9 patients (28%) are female. Thirty-one patients (97%) are white, and 1 patient (3%) is Afro-American. The stages of the patients are: Stage I--7 patients, Stage II--12 patients, Stage III--9 patients, and Stage IV--4 patients. Twenty-one patients (66%) in the early period of the study were staged surgically by staging laparotomy. The most common sites are: neck (84%), mediastinum (66%), and para-aortic lymph nodes (22%). Twenty-five patients (78%) have nodular sclerosing type, 5 patients (16%) have mixed cellularity, and 2 patients (6%) have lymphocytic predominant type. Eight patients (25%) were treated with radiation alone and 24 patients (75%) were treated with a combination of chemotherapy and radiation. Of the radiation group, 5 patients were treated with mantle field; 2 patients with mantle, para-aortic node and splenic pedicles; and 1 patient with mini-mantle field. The treatment was given with 4 or 6 mv photon, and the median dose was 36 Gray (range 32-40 Gy). Of the combination group, 11 patients were treated with ABVD (doxorubicin + bleomycin + vinbastine + dacarbazine), 10 patients with ABVD/MOPP (MOPP: mechlorethamine + vincristine + procarbazine + prednisone) and 3 patients with MOPP alone. The median irradiation dose in the combination group was 25 Gy (range 21 Gy-36 Gy). All the patients in this group were treated to the involved site with custom blocks. Three patients were lost for follow-up because of transfers out-of-state and could not be located. All patients in Stages I and II are alive without any evidence of disease at the last follow-up. One patient with Stage III disease developed a second cancer (PNET: primitive neuroectodermal tumor) 111 months after combination treatment and has died. One Stage IV patient has died with Hodgkin's disease 28 months after treatment with combination therapy. All other patients are followed closely along with the primary physicians and consultants.
1981年至1992年期间，该科室共治疗了32名患者。中位年龄为14岁（范围为4岁至17岁）。10岁以下的患者有6名（19%），11岁至15岁的患者有16名（50%），16岁以上的患者有10名（31%）。23名患者（72%）为男性，9名患者（28%）为女性。31名患者（97%）为白人，1名患者（3%）为非裔美国人。患者的分期情况如下：I期——7名患者，II期——12名患者，III期——9名患者，IV期——4名患者。在研究早期，21名患者（66%）通过分期剖腹探查进行分期手术。最常见的部位是：颈部（84%）、纵隔（66%）和主动脉旁淋巴结（22%）。25名患者（78%）为结节硬化型，5名患者（16%）为混合细胞型，2名患者（6%）为淋巴细胞为主型。8名患者（25%）仅接受放疗，24名患者（75%）接受化疗与放疗联合治疗。在放疗组中，5名患者接受斗篷野放疗；2名患者接受斗篷野、主动脉旁淋巴结和脾蒂放疗；1名患者接受小斗篷野放疗。采用4或6兆伏光子进行治疗，中位剂量为36格雷（范围为32 - 40戈瑞）。在联合治疗组中，11名患者接受ABVD方案（多柔比星 + 博来霉素 + 长春碱 + 达卡巴嗪）治疗，10名患者接受ABVD/MOPP方案（MOPP：氮芥 + 长春新碱 + 丙卡巴肼 + 泼尼松）治疗，3名患者仅接受MOPP方案治疗。联合治疗组的中位照射剂量为25戈瑞（范围为21戈瑞 - 36戈瑞）。该组所有患者均使用定制挡块对受累部位进行治疗。3名患者因转至其他州而失访，无法找到。I期和II期的所有患者在最后一次随访时均存活，无任何疾病迹象。一名III期疾病患者在联合治疗111个月后发生了第二种癌症（原始神经外胚层肿瘤，PNET），现已死亡。一名IV期患者在联合治疗28个月后死于霍奇金病。所有其他患者均由初级医生和会诊医生密切随访。
