Jenkin D, Greenberg M, Fitzgerald A
Toronto-Sunnybrook Regional Cancer Centre, Princess Margaret Hospital, University of Toronto, Canada.
Med Pediatr Oncol. 1996 Jun;26(6):373-9. doi: 10.1002/(SICI)1096-911X(199606)26:6<373::AID-MPO1>3.0.CO;2-E.
This study was undertaken to determine the treatment-specific incidence of second malignant tumours (SMT) in childhood Hodgkin's disease. The institutional databases at The Hospital for Sick Children, the Princess Margaret Hospital, and the Toronto-Bayview Regional Cancer Centre were reviewed for the years 1958-1993. Three hundred and forty-three consecutive newly diagnosed children were evaluated. The overall 30 year cumulative SMT incidence was 31%. The 20 year SMT incidence was greater for patients who relapsed (n = 129), 27%, compared with patients who remained relapse free (n=214), 13%. For patients with stage 1-3B disease who remained relapse free, the 10 year SMT rate was 7% for patients who were surgically staged and treated with extended field radiation treatment (EF RT) (35 G), compared with 3% in clinically staged patients treated with MOPP (six cycles) and EF RT (25-30 G). To date there is no significant difference in the oncogenicity of these treatment protocols. However, EF RT alone was less effective in disease control. For stages 1-3B, 62% of patients relapsed after EF RT alone compared with 18% after bimodal treatment. Therefore treatment intensification due to relapse was more frequent in the former group. The overall 10 year SMT incidence for patients treated with these protocols was 11% and 3%, respectively. The 20 year SMT incidence following EF RT alone was 24%. We conclude that SMTs were a common late complication in childhood Hodgkin's disease and are a limiting factor in the achievement of cure. The incidence of SMTs was increased in children who required retreatment and was minimal in children who remained in a first complete remission. Therefore the initial treatment strategy in childhood Hodgkin's disease must be to minimize the risk of relapse, in order to avoid the morbidity and mortality associated with both relapse and SMT induction, and to achieve this objective with a primary treatment protocol of low oncogenicity.
本研究旨在确定儿童霍奇金病中特定治疗方式下第二原发性恶性肿瘤（SMT）的发病率。回顾了1958年至1993年间病童医院、玛格丽特公主医院和多伦多-湾景地区癌症中心的机构数据库。对343例连续新诊断的儿童进行了评估。30年的SMT总体累积发病率为31%。复发患者（n = 129）的20年SMT发病率为27%，而未复发患者（n = 214）为13%。对于1-3B期未复发的患者，手术分期并用扩大野放射治疗（EF RT）（35 G）的患者10年SMT发生率为7%，而临床分期并用MOPP（六个周期）和EF RT（25 - 30 G）治疗的患者为3%。迄今为止，这些治疗方案的致癌性没有显著差异。然而，单纯EF RT在疾病控制方面效果较差。对于1-3B期，单纯EF RT治疗后62%的患者复发，而双峰治疗后为18%。因此，前一组因复发导致的治疗强化更为频繁。用这些方案治疗的患者总体10年SMT发病率分别为11%和3%。单纯EF RT后的20年SMT发病率为24%。我们得出结论，SMT是儿童霍奇金病常见的晚期并发症，也是实现治愈的限制因素。需要再次治疗的儿童SMT发病率增加，而处于首次完全缓解的儿童发病率最低。因此，儿童霍奇金病的初始治疗策略必须是将复发风险降至最低，以避免与复发和SMT诱发相关的发病率和死亡率，并通过低致癌性的初始治疗方案实现这一目标。
