UO Pneumologia e Fisiopatologia Respiratoria Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano, Italy.
Anticancer Res. 2010 Oct;30(10):4381-7.
The majority of patients with Hodgkin's disease can be cured by combination of polychemotherapy and radiotherapy (RT) that can produce late toxic pulmonary and cardiac effects which often remain at a subclinical level. The aim of the present investigation was to compare the late pulmonary and cardiac toxicity of three chemotherapeutic regimens combined with RT and particularly doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD), vincristine, epirubicin, cyclophosphamide, etoposide and prednisone (VEBEP) and ABVD with mechloretamine, vincristine, procarbazine and prednisone (MOPP).
We investigated 147 patients suffering from Hodgkin's disease after a follow-up of at least 5 years from the completion of CT-RT. Seventy-eight patients were submitted to ABVD-RT, 36 to VEBEP-RT and 33 to MOPP-ABVD-RT. Patients underwent spirometry, 2D-doppler echocardiography at rest, cardiopulmonary exercise test on cycloergometer and determination of cardiac output by a non invasive method.
Patients of the three different treatment groups showed tolerance to exercise, and oxygen consumption significantly lower than the predicted values but there were no statistically significant difference between the three groups. Nevertheless, patients treated with VEBEP and with MOPP-ABVD showed an ejection fraction at rest lower than those observed in the ABVD group and patients treated with VEBEP showed a cardiac output for oxygen uptake lower than those observed in the ABVD and MOPP-ABVD treatment groups.
These data confirm that the combination of mediastinal RT with the more commonly used polychemotherapy regimens produce late toxic effects. The lower exercise capacity seems to be due to a combination of decreased cardiac performance and impairment of ventilation. The VEBEP regimens could be potentially more toxic for the heart, probably because of the higher cumulative dose of anthracyclines.
大多数霍奇金病患者可以通过联合化疗和放疗（RT）治愈，这种治疗会产生晚期毒副作用，影响肺部和心脏，但通常处于亚临床水平。本研究旨在比较三种联合 RT 的化疗方案（多柔比星、博来霉素、长春碱和达卡巴嗪[ABVD]、长春新碱、表柔比星、环磷酰胺、依托泊苷和泼尼松[VEBEP]和氮芥、长春新碱、丙卡巴肼和泼尼松[MOPP]）的晚期肺和心脏毒性，特别是多柔比星。
我们对至少完成 CT-RT 后 5 年随访的 147 例霍奇金病患者进行了调查。78 例患者接受 ABVD-RT，36 例患者接受 VEBEP-RT，33 例患者接受 MOPP-ABVD-RT。患者接受了肺量测定、静息二维多普勒超声心动图、踏车心肺运动试验和非侵入性方法测定心输出量。
三组不同治疗组的患者均能耐受运动，耗氧量明显低于预计值，但三组间无统计学差异。然而，接受 VEBEP 和 MOPP-ABVD 治疗的患者静息时射血分数低于 ABVD 组，接受 VEBEP 治疗的患者每单位耗氧量的心输出量低于 ABVD 和 MOPP-ABVD 治疗组。
这些数据证实纵隔 RT 联合更常用的联合化疗方案会产生晚期毒性作用。运动能力下降可能是由于心脏功能下降和通气受损的综合作用。VEBEP 方案可能对心脏更具毒性，可能是由于累积的蒽环类药物剂量较高。
