Lobo-Sanahuja F, García I, Barrantes J C, Barrantes M, González M, Jiménez R
Oncology Department, National Children's Hospital, San José, Costa Rica.
Med Pediatr Oncol. 1994;22(6):398-403. doi: 10.1002/mpo.2950220609.
This is a prospective and nonrandomized study in which 86 children with previously untreated Hodgkin's disease (HD) were clinically staged (CS) and treated with chemotherapy (CT) alone. Fifty-two (CS IA-38, IIA-7, IIB-3, IIIA-4) received six courses of cyclophosphamide, vinblastine, procarbazine, and prednisone (CVPP). Ten (CS IA with peripheral nodes) received only three courses of CVPP with a reinforcement of C on day 8. Twenty-four (CS IIIB-18, IVA-2, IVB-4) received six courses of CVPP alternating with six courses of epirubicin, bleomycin, and vincristine (EBO). Surgical staging was not performed in any patient. Two patients (CS IIIB) had partial remission and died from progressive disease. Seventy out of 86 children have not relapsed and are in complete remission with a median follow-up of 65 months (range 13-156 months); 14 children relapsed seven to 37 months from diagnosis (median 16 months); one of them (IV B) died of disease. Thirteen are in second and third remission (median 55 months). Actuarial five year survival rates and relapse-free survival rates are 100% and 90% for CS I to IIIA and 81% and 60% for CS IIIB and IV, respectively. As a result of this study, we can conclude that in developing countries most of the children with HD staged by noninvasive diagnostic techniques can be cured with CT alone as primary treatment and thus will not suffer from the late effects of radiotherapy (RT) and the morbidity of laparotomy and splenectomy. RT alone or with other CT combinations should be considered for children who develop relapse of HD.
这是一项前瞻性非随机研究，86例既往未经治疗的霍奇金病（HD）患儿接受了临床分期（CS）并仅接受化疗（CT）。52例（CS IA - 38例、IIA - 7例、IIB - 3例、IIIA - 4例）接受了六个疗程的环磷酰胺、长春碱、丙卡巴肼和泼尼松（CVPP）。10例（外周淋巴结受累的CS IA）仅接受三个疗程的CVPP，并在第8天加强使用环磷酰胺（C）。24例（CS IIIB - 18例、IVA - 2例、IVB - 4例）接受六个疗程的CVPP与六个疗程的表柔比星、博来霉素和长春新碱（EBO）交替使用。所有患者均未进行手术分期。2例（CS IIIB）部分缓解，死于疾病进展。86例患儿中有70例未复发，处于完全缓解状态，中位随访时间为65个月（范围13 - 156个月）；14例患儿在诊断后7至37个月复发（中位时间16个月）；其中1例（IV B）死于疾病。13例处于第二次和第三次缓解期（中位时间55个月）。CS I至IIIA的精算五年生存率和无复发生存率分别为100%和90%，CS IIIB和IV分别为81%和60%。根据这项研究，我们可以得出结论，在发展中国家，大多数通过非侵入性诊断技术分期的HD患儿仅用CT作为主要治疗即可治愈，因此不会遭受放疗（RT）的晚期效应以及剖腹术和脾切除术的发病率。对于HD复发的患儿，应考虑单独放疗或放疗与其他化疗联合使用。
