Ilhan I, Sarialioglu F, Ozbarlas N, Büyükpamukçu M, Akyüz C, Kutluk T
Dr Sami Ulus Childrens' Hospital, Ankara, Turkey.
Postgrad Med J. 1995 Mar;71(833):164-7. doi: 10.1136/pgmj.71.833.164.
Twenty-four patients under 18 years when treated for Hodgkin's disease (20 male, four female) were examined no less than five years after the completion of the treatment. The mean age was 17 years (range 9.5-25.0 years) at the time of study. All patients received six courses of cyclophosphamide-oncovin-procarbazine-prednisolone chemotherapy; in addition, nine patients received low-dose radiotherapy excluding the mediastinum and eight of 24 patients received mediastinal radiotherapy; the dose was between 20-30 Gy. All patients had normal cardiovascular findings on clinical examination. ECG and chest radiography were within normal limits in all patients. Resting left ventricular ejection fraction and fractional shortening were decreased in only one patient (4%), but there was no significant difference between the patient group and a control group for left ventricular systolic function (p > 0.05). In the patient group, early diastolic peak velocity, peak velocity at atrial contraction, left ventricular isovolumic relaxation time, and the rate of decrease of flow velocity in early diastole were significantly different from that of the control group (p < 0.05). In conclusion, the late effects of our treatment protocol for Hodgkin's disease appear to be minimal. These observations support combined modality, low-dose irradiation regimens in children and adolescents and suggest the need for careful cardiac screening of treated patients.
24例18岁以下接受霍奇金病治疗的患者（20例男性，4例女性）在完成治疗后至少5年接受了检查。研究时的平均年龄为17岁（范围9.5 - 25.0岁）。所有患者均接受了6个疗程的环磷酰胺-长春新碱-丙卡巴肼-泼尼松化疗；此外，9例患者接受了不包括纵隔的低剂量放疗，24例患者中有8例接受了纵隔放疗；剂量在20 - 30 Gy之间。所有患者临床检查时心血管检查结果均正常。所有患者的心电图和胸部X线检查均在正常范围内。仅1例患者（4%）静息左心室射血分数和缩短分数降低，但患者组与对照组的左心室收缩功能无显著差异（p > 0.05）。在患者组中，舒张早期峰值速度、心房收缩期峰值速度、左心室等容舒张时间以及舒张早期血流速度下降率与对照组有显著差异（p < 0.05）。总之，我们的霍奇金病治疗方案的晚期效应似乎最小。这些观察结果支持儿童和青少年联合应用低剂量照射方案，并提示需要对接受治疗的患者进行仔细的心脏筛查。
