Prosnitz L R, Lawson J P, Friedlaender G E, Farber L R, Pezzimenti J F
Cancer. 1981 Jun 15;47(12):2793-7. doi: 10.1002/1097-0142(19810615)47:12<2793::aid-cncr2820471206>3.0.co;2-a.
Avascular necrosis of bone developed in eight patients with advanced Hodgkin's disease who had been treated with combined modality therapy and were in complete remission from their disease. A ninth patient not on protocol but treated with the combined modality program also developed avascular necrosis. The cumulative incidence was 10% among long-term survivors. The etiology is unclear. Prolonged corticosteroid administration has been implicated but usually in much larger doses than the patients in this series received. The possible roles of the other chemotherapeutic agents for Hodgkin's disease, and radiation are discussed. Considerable disability resulted for almost all patients. Three of seven patients primarily with avascular necrosis of the femoral heads had bilateral hip replacements with surgery anticipated in four others. The two patients primarily with humeral head involvement have limited use of their arms. This condition must be added to the known possible serious consequences of combination chemotherapy for Hodgkin's disease. It is uncertain if the frequency of avascular necrosis is higher in patients treated with both radiation and chemotherapy compared with chemotherapy alone. Further studies are needed from other institutions to clarify the frequency and cause of this problem.
8例晚期霍奇金病患者在接受综合治疗并完全缓解后发生了骨缺血性坏死。第9例未按方案治疗但接受了综合治疗方案的患者也发生了骨缺血性坏死。长期存活者的累积发病率为10%。病因尚不清楚。长期使用皮质类固醇被认为是一个因素，但通常剂量比本系列患者接受的剂量大得多。文中讨论了其他霍奇金病化疗药物以及放疗可能起到的作用。几乎所有患者都出现了严重的功能障碍。7例主要为股骨头缺血性坏死的患者中有3例行双侧髋关节置换术，另外4例预计也将接受手术。2例主要累及肱骨头的患者手臂活动受限。这种情况必须被列入已知的霍奇金病联合化疗可能导致的严重后果之中。与单纯化疗相比，接受放疗和化疗的患者骨缺血性坏死的发生率是否更高尚不确定。其他机构需要进一步开展研究以明确该问题的发生率和病因。
