Donaldson S S, Link M P
Department of Radiation Oncology, Stanford University Medical Center, California.
Pediatr Clin North Am. 1991 Apr;38(2):457-73. doi: 10.1016/s0031-3955(16)38087-7.
Age of a patient when afflicted with Hodgkin's disease is an important prognostic factor. Although there are histologic and stage differences as a function of age, the younger a patient is when diagnosed, the better the cure rate. Youngsters less than age 10 years have a freedom from relapse of 80% at 26 years follow-up examination; adolescents in the 11 to 16 age group have a freedom from relapse or 74%; and adults aged 17 years or older have a freedom from relapse of 64%. These differences translate into significant survival differences as well, with children aged 10 years or younger and those aged 11 to 16 years having a 26-year survival of 74%, as compared to adults, who have a 37% survival (P = 0.003). These differences remain significant when comparing those with stage I and II disease, as opposed to those with advanced stage III and IV disease. Children present the greatest challenges with respect to staging and treatment. The older child with localized disease can be managed appropriately as an adult. However, for the younger child the use of low-dose radiation and multiagent chemotherapy is widely accepted. Using this approach, survival rates of 85% or greater are reported from many large institutional and cooperative group experiences. The goals of treatment today are cure of disease, with maximal quality of life and minimal complications from the treatment. The late effects of greatest importance to the youngest children are skeletal and bone growth abnormalities, sterility, and malignant tumor induction. Treatment programs today should be directed towards refining therapy to minimize sequelae while maximizing quality of life. These goals are best achieved when children are managed in regional centers with demonstrated expertise in the management of children with Hodgkin's disease. Whereas cure can be achieved in a large majority of children diagnosed with Hodgkin's disease, our challenge is cure, with the least sequelae and the greatest quality of life. "Children are not simply micro-adults, but have their own specific problems."
患霍奇金病时患者的年龄是一个重要的预后因素。尽管根据年龄存在组织学和分期差异，但患者诊断时越年轻，治愈率越高。10岁以下的儿童在26年随访检查时复发率为80%；11至16岁年龄组的青少年复发率为74%；17岁及以上的成年人复发率为64%。这些差异也转化为显著的生存差异，10岁及以下儿童和11至16岁儿童的26年生存率为74%，而成人的生存率为37%（P = 0.003）。与晚期III期和IV期疾病患者相比，I期和II期疾病患者之间的这些差异仍然显著。儿童在分期和治疗方面面临最大挑战。患有局限性疾病的大龄儿童可以像成人一样得到适当治疗。然而，对于年幼的儿童，低剂量放疗和多药化疗的使用已被广泛接受。采用这种方法，许多大型机构和合作组的经验报告显示生存率达到85%或更高。当今治疗的目标是治愈疾病，同时使生活质量最大化，治疗并发症最小化。对最年幼的儿童来说最重要的晚期影响是骨骼和骨生长异常、不育和诱发恶性肿瘤。当今的治疗方案应旨在优化治疗，以尽量减少后遗症，同时最大化生活质量。当儿童在对霍奇金病患儿管理方面具有专业知识的区域中心接受治疗时，这些目标最能实现。虽然大多数被诊断为霍奇金病的儿童可以治愈，但我们面临的挑战是在后遗症最少、生活质量最高的情况下实现治愈。“儿童并非简单的小成人，而是有其自身特定的问题。”
