在霍奇金病患儿的治疗中采用累及野（IF）照射联合或不联合化疗。

Involved field (IF) irradiation with or without chemotherapy in the management of children with Hodgkin's disease.

作者信息

Jereb B, Tan C, Bretsky S, He S Q, Exelby P

出版信息

Med Pediatr Oncol. 1984;12(5):325-32. doi: 10.1002/mpo.2950120506.

DOI:10.1002/mpo.2950120506

Abstract

The present policy at Memorial Sloan Kettering Cancer Center (MSKCC) of treating children with Hodgkin's disease [HD] is as follows: involved field (IF) irradiation only (3,600 rad) for Stages IA and IIA; IF irradiation (2,400 or 2,000 rad) combined with multidrug chemotherapy (MDP) protocol for all other stages. A somewhat higher recurrence rate is accepted for Stages IA and IIA in view of the good salvage rate for these recurrences and in view of side effects of more aggressive types of radiation treatment. One hundred forty-two patients with HD, 2-19 years of age, were treated at MSKCC between 1970 and 1981; 98 of these were treated according to the present policy (SP group), and 44 (NP group) were treated differently. All SP patients underwent staging laparotomy. The follow-up time was 12 to 146 months with a median of 65 months; two patients were lost to follow-up. For the SP group, all stages, 10-year disease-free survival is 77%, and 10-year survival is 93%. By comparison, in the NP group 10-year disease-free survival is 64%, and 10-year survival is 80%. The disease-free survival of SP patients in Stages IA and IIA treated with IF radiation alone is 72%, and survival is 95%. The disease-free survival of SP patients in advanced stages treated with combined radiation and chemotherapy is 87%; the salvage rate of recurrent disease in these stages is poor. The survival was apparently better (P = 0.07) in the SP group as compared to the NP group. All 6 patients of the SP group who died had a nodular sclerosing type of HD. None of the patients in the SP group have developed secondary malignancies, and no severe bone growth retardations or late effects to other organs were observed. In our opinion, IF irradiation alone might at present be suitable treatment for children in Stages IA and IIA of Hodgkin's disease, and addition of IF radiation with low doses of MPD improves the survival of patients in advanced stages.

摘要

纪念斯隆凯特琳癌症中心（MSKCC）目前治疗儿童霍奇金病（HD）的政策如下：IA期和IIA期仅采用累及野（IF）照射（3600拉德）；所有其他期采用IF照射（2400或2000拉德）联合多药化疗（MDP）方案。鉴于IA期和IIA期复发的良好挽救率以及更积极的放射治疗类型的副作用，对于这两个分期，接受稍高的复发率。1970年至1981年间，MSKCC治疗了142例2至19岁的HD患者；其中98例按照现行政策治疗（SP组），44例（NP组）采用不同治疗方法。所有SP组患者均接受分期剖腹术。随访时间为12至146个月，中位时间为65个月；2例患者失访。对于SP组所有分期，10年无病生存率为77%，10年生存率为93%。相比之下，NP组10年无病生存率为64%，10年生存率为80%。仅接受IF照射治疗的IA期和IIA期SP组患者无病生存率为72%，生存率为95%。接受放疗和化疗联合治疗的晚期SP组患者无病生存率为87%；这些分期复发疾病的挽救率较差。与NP组相比，SP组的生存率明显更好（P = 0.07）。SP组死亡的所有6例患者均为结节硬化型HD。SP组患者均未发生继发性恶性肿瘤，未观察到严重的骨骼生长发育迟缓或对其他器官的晚期影响。我们认为，目前仅IF照射可能适合霍奇金病IA期和IIA期的儿童，低剂量MPD联合IF照射可提高晚期患者的生存率。