Balwierz Walentyna, Klekawka Tomasz, Moryl-Bujakowska Angelina, Matysiak Michał, Sopyło Barbara, Wachowiak Jacek, Kaczmarek-Kanold Małgorzata, Sońta-Jakimczyk Danuta, Janik-Moszant Anna, Chybicka Alicja, Chaber Robert, Kowalczyk Jerzy R, Mitura-Lesiuk Małgorzata, Balcerska Anna, Stachowicz-Stencel Teresa, Wysocki Mariusz, Kołtan Andrzej, Krawczuk-Rybak Maryna, Muszyńska-Rosłan Katarzyna, Młynarski Wojciech, Stolarska Małgorzata, Sobol Grazyna, Wieczorek Maria, Karolczyk Grazyna, Urbanek-Dadela Agnieszka
Klinika Onkologii i Hematologii Dzieciecej, PA Instytut Pediatrii UJ CM, Kraków.
Przegl Lek. 2010;67(6):375-81.
Currently over 90% of children and adolescents with Hodgkin's disease (HD) can be cured thanks to use of multidrug chemotherapy (CT) combined with involved-field radiotherapy (IF-RT). However, the intensive treatment may increase the risk of late complications which may impair the patients' quality of life. In order to decrease the incidence of late complications the protocol with limited use of IF-RT was introduced in centers of Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG). This study presents the treatment results of patients treated with CT only in comparison with the therapy results of children treated with CT and IF-RT. From 1997 to 2006, 634 children (age: 2-22,5 years) with HD were treated in 14 oncological centers of PPLLSG. Majority of patients received CT (3-8 cycles of MVPP/B-DOPA) combined with IF-RT. In 45 patients with IA-IIA stages presenting favorable risk factors (small mediastinal tumor, peripheral nodular mass of a maximum diameter < 6 cm, involvement of less than three nodular regions, ESR < 50 mm after 1 h, histologic type other than lymphocyte depletion and very good treatment response assessed after 3 CT cycles) IF-RT was omitted. Among 634 children first complete remission (RC) was not achieved in 2.4% of patients. Relapses occurred in 24 children (3.9%). The rates of 5-year overall survival (OS), relapse-free survival (RFS) and event-free survival (EFS) were 97%, 96% i 92%, respectively. All patients treated with CT only remain in first CR. All serious late complications (including 7 second neoplasms) occurred in patients treated with CT combined with RT. Seven children died because of severe complications, among them two in first CR (aplastic anemia, sepsis). Our results show that the use of CT only in precisely selected group of patients with HD do not impair the treatment results and may decrease the risk of late life threatening complications. Treatment response assessment with the use of PET may in future increase the number of patients treated without RT and limit the need of the use of invasive diagnostic methods in patients with residual mass.
目前，由于采用了多药化疗（CT）联合受累野放疗（IF-RT），超过90%的霍奇金淋巴瘤（HD）儿童和青少年患者可以治愈。然而，强化治疗可能会增加晚期并发症的风险，这可能会损害患者的生活质量。为了降低晚期并发症的发生率，波兰儿童白血病/淋巴瘤研究组（PPLLSG）的中心引入了有限使用IF-RT的方案。本研究展示了仅接受CT治疗的患者的治疗结果，并与接受CT和IF-RT治疗的儿童的治疗结果进行了比较。1997年至2006年，PPLLSG的14个肿瘤中心对634名HD儿童（年龄：2至22.5岁）进行了治疗。大多数患者接受了CT（3至8个周期的MVPP/B-DOPA）联合IF-RT。45例IA-IIA期且具有有利风险因素的患者（小纵隔肿瘤、最大直径<6 cm的外周结节性肿块、累及少于三个结节区域、1小时后血沉<50 mm、非淋巴细胞消减组织学类型且在3个CT周期后评估治疗反应非常好）未接受IF-RT。在634名儿童中，2.4%的患者未实现首次完全缓解（RC）。24名儿童（3.9%）出现复发。5年总生存率（OS）、无复发生存率（RFS）和无事件生存率（EFS）分别为97%、96%和92%。所有仅接受CT治疗的患者均保持首次完全缓解。所有严重的晚期并发症（包括7例第二肿瘤）均发生在接受CT联合放疗的患者中。7名儿童因严重并发症死亡，其中2名处于首次完全缓解期（再生障碍性贫血、败血症）。我们的结果表明，仅在经过精确选择的HD患者组中使用CT不会损害治疗效果，并且可能会降低晚期危及生命并发症的风险。未来，使用PET进行治疗反应评估可能会增加无需放疗的患者数量，并减少对残留肿块患者使用侵入性诊断方法的需求。
