Rubin P, Zagars G, Chuang C, Thomas E M
Int J Radiat Oncol Biol Phys. 1986 Feb;12(2):153-66. doi: 10.1016/0360-3016(86)90088-x.
Three hundred-twenty patients with Hodgkin's disease (HD) were studied retrospectively to assess the impact of treatment on survival and the development of second malignant neoplasms (SMN). All stages of HD were considered. Treatment groups included XRT only, XRT + multiagent chemotherapy (MAC), XRT + single agent chemotherapy (SAC), and chemotherapy only (Chemo). MAC was subdivided into MOPP and non-MOPP regimens. Twenty-one patients developed 23 SMN, only two of which were acute leukemias. Survival was greatest for XRT only because of a large proportion of early stage HD in this group. SMN were seen in all treatment groups except Chemo only. The XRT + MAC group had a significantly elevated observed-to-expected ratio for SMN, but it was difficult to attribute this to either MOPP or non-MOPP due to very small numbers of patients. The actuarial risk of SMN for both MOPP and non-MOPP rises dramatically between 10 and 15 years, however, extrapolation cannot be done, again because of very small numbers. We conclude that there is an increased risk of SMN in patients treated aggressively for HD, but that the exact cause of SMN is difficult to determine.
对320例霍奇金淋巴瘤（HD）患者进行回顾性研究，以评估治疗对生存及第二原发性恶性肿瘤（SMN）发生的影响。研究涵盖了HD的所有分期。治疗组包括单纯放疗（XRT）、放疗+多药联合化疗（MAC）、放疗+单药化疗（SAC）以及单纯化疗（Chemo）。MAC又细分为MOPP方案和非MOPP方案。21例患者发生了23例SMN，其中仅有2例为急性白血病。单纯放疗组的生存率最高，因为该组中早期HD患者比例较大。除单纯化疗组外，其他所有治疗组均观察到了SMN。放疗+MAC组的SMN观察/预期比值显著升高，但由于患者数量极少，很难将其归因于MOPP方案或非MOPP方案。然而，MOPP方案和非MOPP方案的SMN精算风险在10至15年之间均显著上升，同样由于患者数量极少，无法进行外推。我们得出结论，接受积极治疗的HD患者发生SMN的风险增加，但SMN的确切病因难以确定。
