Song Kye Jin, Park Jin-Hong, Im Ho Joon, Ahn Seung Do
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
Radiat Oncol J. 2020 Sep;38(3):198-206. doi: 10.3857/roj.2020.00346. Epub 2020 Sep 17.
To analyze the clinical outcomes and long-term toxicity of pediatric patients with Hodgkin lymphoma after combined-modality treatment (CMT) with involved-field or involved-nodal radiotherapy (RT).
We retrospectively reviewed the records of 27 pediatric Hodgkin lymphoma patients who received CMT at a single institution between January 1990 and July 2017. Patients with stage I-III received a heterogeneous chemotherapy regimen depending on their risk group followed by 19.8-36 Gy RT, with the dose based on their response to the chemotherapy before RT. An optional 9-20 Gy boost was delivered to residual sites. The risk group was determined based on the initial stage, the presence of bulky disease, and any B symptoms. We evaluated overall survival, event-free survival, and long-term toxicities.
A total of 27 patients completed the CMT. At a median follow-up of 125 months (range, 9 to 337 months), the estimated 5-year event-free survival and overall survival were 88.9% and 96.3%, respectively. Late symptomatic cardiopulmonary toxicity was not observed, and only one patient was positive on a subclinical obstructive pulmonary function test. The incidence of hypothyroidism was 58.3% among 12 patients with an available thyroid function test. There was one papillary thyroid cancer diagnosed 7.2 years after treatment.
CMT for pediatric Hodgkin lymphoma with involved-field and involved-nodal RT achieved an excellent survival with only modest long-term toxicity. Smaller-field RT seemed to decrease long-term toxicities and had good local control.
分析接受累及野或累及淋巴结放疗（RT）的综合治疗（CMT）的儿童霍奇金淋巴瘤患者的临床结局和长期毒性。
我们回顾性分析了1990年1月至2017年7月在单一机构接受CMT的27例儿童霍奇金淋巴瘤患者的记录。I - III期患者根据其风险组接受异质性化疗方案，随后进行19.8 - 36 Gy的放疗，剂量根据放疗前对化疗的反应而定。对残留部位给予9 - 20 Gy的选择性增强放疗。风险组根据初始分期、大包块疾病的存在以及任何B症状来确定。我们评估了总生存、无事件生存和长期毒性。
共有27例患者完成了CMT。中位随访125个月（范围9至337个月），估计5年无事件生存率和总生存率分别为88.9%和96.3%。未观察到晚期有症状的心肺毒性，只有1例患者在亚临床阻塞性肺功能测试中呈阳性。在12例可进行甲状腺功能测试的患者中，甲状腺功能减退的发生率为58.3%。治疗后7.2年诊断出1例甲状腺乳头状癌。
采用累及野和累及淋巴结放疗的CMT治疗儿童霍奇金淋巴瘤可获得优异的生存率，且长期毒性较小。较小野放疗似乎可降低长期毒性并具有良好的局部控制效果。
