儿童霍奇金病的化疗与放疗
Chemotherapy and irradiation in childhood Hodgkin's disease.
作者信息
Robinson B, Kingston J, Nogueira Costa R, Malpas J S, Barrett A, McElwain T J
出版信息
Arch Dis Child. 1984 Dec;59(12):1162-7. doi: 10.1136/adc.59.12.1162.
Eighty children aged less than 16 years with newly diagnosed Hodgkin's disease were treated between 1974 and 1982. Complete remission occurred in 95%, with actuarial five year overall survival of 94%, and relapse free survival of 82%: median follow up was 4.8 years. Sixty one children were staged clinically while 19 had staging laparotomies before treatment. Most received combined modality treatment with Ch1VPP chemotherapy (chlorambucil, vinblastine, procarbazine, and prednisolone) followed by irradiation of initial bulk disease. Nodular sclerosis predominated in both sexes, accounting for 60% of the total. Girls with stage IV disease, nodal sclerosis histology, and bulky mediastinal masses had a relatively poor prognosis. Ten children have relapsed, and three prolonged (6 to 7 years) second remissions have been observed. Four died of disease, and one from infection. Clinical staging, avoiding splenectomy, reduced the risk of serious infections. Our current policy is to treat stage IA disease with local irradiation and all other stages with chemotherapy, adding irradiation for bulky mediastinal disease.
1974年至1982年间，对80名年龄小于16岁的新诊断霍奇金病患儿进行了治疗。95%的患儿实现完全缓解，5年实际总生存率为94%，无复发生存率为82%：中位随访时间为4.8年。61名患儿进行了临床分期，19名在治疗前接受了分期剖腹探查术。大多数患儿接受了联合治疗，采用Ch1VPP化疗（苯丁酸氮芥、长春花碱、丙卡巴肼和泼尼松龙），随后对初始大块病灶进行放疗。结节硬化型在男女中均占主导，占总数的60%。患有IV期疾病、结节硬化组织学类型且纵隔肿块较大的女孩预后相对较差。10名患儿复发，观察到3例延长（6至7年）的第二次缓解。4名患儿死于疾病，1名死于感染。临床分期并避免脾切除术降低了严重感染的风险。我们目前的策略是，对IA期疾病采用局部放疗，对所有其他期疾病采用化疗，对纵隔肿块较大的疾病加用放疗。
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