Mefferd J M, Donaldson S S, Link M P
Stanford University Medical Center, Stanford, CA 94305.
Int J Radiat Oncol Biol Phys. 1989 Mar;16(3):679-85. doi: 10.1016/0360-3016(89)90485-9.
Since pediatric Hodgkin's disease is a curable malignancy, it is essential to limit treatment sequelae. This study examines post-treatment pulmonary, cardiac, and thyroid function in 34 children, ages 5 to 17 (23 male and 11 female) with Hodgkin's disease. All received combined modality therapy of 6 cycles of alternating ABVD/MOPP chemotherapy and low dose (1500-2500 cGy) involved field radiotherapy. Mean follow-up period is 27.5 months with actuarial freedom from relapse of 94% and survival of 92%. Twenty asymptomatic patients underwent pulmonary function testing following chemotherapy and supradiaphragmatic radiotherapy. Eleven patients had post-treatment carbon monoxide diffusing capacity (DLCO) performed. Six of 11 children (55%) had abnormal values (mean 66%, range 58-80) showing either a reduced DLCO compared to pretreatment or an low absolute value. Eight of the twenty patients (40%) tested post-treatment for FEV1, FVC, TLC and flow volume loop had abnormal results. Six showed restrictive abnormalities and two had obstructive dysfunction. Fourteen patients underwent cardiac nuclear gated angiogram after completion of chemotherapy. Two asymptomatic patients (14%) had abnormal scans showing either a low resting ejection fraction or a decreased response to exercise. Thyroid function was evaluated post-treatment in twenty-one patients by TSH, T4, free T4 or sensitive TSH analysis. Four (21%) had an elevated TSH with a normal T4 after treatment. Although post-treatment thyroid and cardiac effects were minimal, post-treatment pulmonary dysfunction in asymptomatic patients was substantial with more than 50% of tested children demonstrating an abnormal DLCO and 40% showing restrictive or obstructive pulmonary parameters. These abnormalities were observed following a maximum bleomycin dose of 60 units/m2. Bleomycin and pulmonary radiotherapy have adverse effects on diffusing capacity and the long-term pulmonary sequlae of combined ABVD chemotherapy and radiotherapy are unknown. Our analysis suggests that even in asymptomatic children, pulmonary abnormalities are frequent.
由于儿童霍奇金病是一种可治愈的恶性肿瘤，因此限制治疗后遗症至关重要。本研究调查了34名年龄在5至17岁（23名男性和11名女性）的霍奇金病患儿治疗后的肺、心脏和甲状腺功能。所有患儿均接受了6个周期交替ABVD/MOPP化疗和低剂量（1500 - 2500 cGy）受累野放疗的综合治疗。平均随访期为27.5个月，无复发生存率为94%，生存率为92%。20名无症状患儿在化疗和膈上放疗后进行了肺功能测试。11名患儿进行了治疗后一氧化碳弥散量（DLCO）检测。11名儿童中有6名（55%）检测值异常（平均66%，范围58 - 80），显示与治疗前相比DLCO降低或绝对值较低。20名患儿中有8名（40%）在治疗后进行了FEV1、FVC、TLC和流量容积环检测，结果异常。6名显示限制性异常，2名有阻塞性功能障碍。14名患儿在化疗结束后进行了心脏核素门控血管造影。2名无症状患儿（14%）扫描结果异常，显示静息射血分数低或运动反应降低。21名患儿在治疗后通过TSH、T4、游离T4或敏感TSH分析评估了甲状腺功能。4名（21%）患儿治疗后TSH升高而T4正常。尽管治疗后甲状腺和心脏影响最小，但无症状患儿治疗后肺功能障碍严重，超过50%的检测儿童DLCO异常，40%显示限制性或阻塞性肺参数异常。这些异常是在博来霉素最大剂量为60单位/m²后观察到的。博来霉素和肺部放疗对弥散量有不良影响，联合ABVD化疗和放疗的长期肺部后遗症尚不清楚。我们的分析表明，即使是无症状儿童，肺部异常也很常见。
