Hernández-Benítez Josué, López-Azcarraga Alejandra, Flerlage Jamie E, Castellino Sharon, Aristizabal Paula, Hoppe Bradford S, Milgrom Sarah A, de Paula Mario José Aguiar, Mailhot Vega Raymond B
Department of Radiation Oncology, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México.
Department of Radiation Oncology, Hospital Infatil de México Federico Gómez, Ciduad de México, México.
JCO Glob Oncol. 2025 Jun;11:e2400485. doi: 10.1200/GO-24-00485. Epub 2025 Jun 26.
Doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy is used commonly for pediatric Hodgkin lymphoma (pHL) in low- and middle-income countries. The role of radiotherapy (RT) after ABVD in pHL is uncertain.
We conducted a systematic review to explore the use of ABVD with or without RT in pHL. Key clinical questions included the number of cycles of ABVD, indications for and dose of RT, and outcomes by risk group. A search was performed in PubMed. Articles reporting survival outcomes by risk group were included.
Of 97 articles identified in the literature search, nine met inclusion criteria. Chemotherapy consisted of four to six cycles in limited disease and mostly six cycles in advanced disease. Three studies used RT for all patients within a specified risk group. Six studies dictated an adapted RT approach, with 3%-43% of the patients receiving RT for bulky adenopathy, slow early response (SER), and/or incomplete response. Radiation doses ranged between 20 and 36 Gy. The progression-free survival and overall survival at 4-10 years ranged from 84% to 100% and 93%-100% in limited disease and 50%-84.4% and 75%-95.3% in advanced disease, respectively. Studies did not directly assess the impact of certain chemotherapy or RT strategies. Recommendations were made after reviewing outcomes with particular approaches.
Four cycles of ABVD are recommended for limited disease, and six cycles of ABVD are recommended for advanced disease. In both limited and advanced diseases, RT is recommended with a dose of 20-21 Gy only to sites of bulky and/or SER, with a boost of up to 36 Gy to sites of incomplete response. This approach could spare radiation for at least half of the patients with limited disease and one third of advanced disease.
在低收入和中等收入国家，多柔比星、博来霉素、长春碱和达卡巴嗪（ABVD）化疗常用于儿童霍奇金淋巴瘤（pHL）。ABVD化疗后放疗（RT）在pHL中的作用尚不确定。
我们进行了一项系统评价，以探讨pHL中使用或不使用RT的ABVD治疗情况。关键临床问题包括ABVD的疗程数、RT的适应证和剂量以及不同风险组的治疗结果。在PubMed上进行了检索。纳入了按风险组报告生存结果的文章。
在文献检索中确定的97篇文章中，9篇符合纳入标准。化疗方案为局限性疾病采用4至6个周期，晚期疾病大多采用6个周期。三项研究对特定风险组的所有患者使用了RT。六项研究采用了调整后的RT方法，3%至43%的患者因肿大淋巴结、早期反应缓慢（SER）和/或不完全缓解而接受RT。放疗剂量在20至36 Gy之间。局限性疾病4至10年的无进展生存率和总生存率分别为84%至100%和93%至100%，晚期疾病分别为50%至84.4%和75%至95.3%。研究未直接评估某些化疗或RT策略的影响。在审查特定方法的结果后提出了建议。
局限性疾病推荐4个周期的ABVD化疗，晚期疾病推荐6个周期的ABVD化疗。在局限性和晚期疾病中，均建议仅对肿大和/或SER部位给予20至21 Gy的放疗剂量，对不完全缓解部位追加至36 Gy的放疗剂量。这种方法可为至少一半的局限性疾病患者和三分之一的晚期疾病患者避免放疗。
