Bossi G, Cerveri I, Volpini E, Corsico A, Baio A, Corbella F, Klersy C, Arico M
Department of Pediatrics, University of Pavia, IRCCS Policlinico San Matteo, Italy.
Ann Oncol. 1997;8 Suppl 1:19-24.
Pulmonary sequelae have been reported in patients treated for Hodgkin's disease (HD). Few data are available about patients treated for childhood HD followed over several years.
In a cross-sectional study carried out for 76 months (median time) after treatment completion, we evaluated the lung function abnormalities and respiratory symptoms in 27 patients (16 males and 11 females) with HD diagnosed between 1983 and 1994 (median age at diagnosis 11 years, range 2-16 years). They had been treated with chemotherapy and radiotherapy according to current protocol AIEOP-MH 83 (n = 14) or AIEOP-MH 89 (n = 13). At the time of the study, 26 patients were in first complete remission and one in second remission. Of the 27 patients, 19 had had mediastinal irradiation at a dose of 20 Gy (n = 5) or 20.8-44 Gy (n = 14). Forced vital capacity (FVC), functional residual capacity (FRC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, and maximal expiratory flow at 25% of FVC were registered; diffusion capacity for carbon monoxide (DLCO) was determined. Data were expressed as standard deviation (SD) score. Four patterns of respiratory function abnormalities were defined: restrictive, obstructive, isolated bronchiolar impairment, isolated diffusing impairment.
Twelve patients (44%) were asymptomatic and showed completely normal pulmonary function tests. Three patients reported dyspnea on exertion, and one of them also cough and phelgm: out of these symptomatic subjects, only 1 had functional abnormality (isolated DLCO impairment). A restrictive pattern was found in 5 patients (18%), including 2 who also had a pathological DLCO SD score. Eight additional patients (30%) had isolated diffusing impairment. Oxygen saturation was normal in all patients. Forty-seven percent of patients with normal DLCO had had lower dose irradiation (20 Gy) compared to 10% of patients with impaired DLCO (P = 0.054). Similarly, patients with normal DLCO had had significantly less chemotherapy as compared to patients with abnormal DLCO (P = 0.003). Occurrence of lung abnormalities was not significantly associated with sex, age at treatment, mediastinal irradiation, and time elapsed from treatment completion.
Adolescents and young adults treated for childhood HD are at risk for lung function abnormalities, significantly more frequent in patients who received more intense treatment, as mediastinal irradiation at a higher dose (> 20 Gy) and more chemotherapy blocks. Long-term follow-up should be offered to these patients because of their possible limited potential for pulmonary function and possible lesser resistance to adverse agents such as smoke, pollution, infections and aging.
已有报道称霍奇金淋巴瘤(HD)患者存在肺部后遗症。关于接受多年随访的儿童HD患者的数据较少。
在治疗结束后的76个月(中位时间)进行的一项横断面研究中,我们评估了1983年至1994年间确诊的27例HD患者(16例男性和11例女性)的肺功能异常和呼吸道症状(诊断时的中位年龄为11岁,范围为2至16岁)。他们根据当前的AIEOP - MH 83方案(n = 14)或AIEOP - MH 89方案(n = 13)接受了化疗和放疗。在研究时,26例患者处于首次完全缓解期,1例处于第二次缓解期。27例患者中,19例接受了20 Gy(n = 5)或20.8 - 44 Gy(n = 14)的纵隔照射。记录了用力肺活量(FVC)、功能残气量(FRC)、一秒用力呼气量(FEV1)、FEV1/FVC比值以及FVC的25%时的最大呼气流量;测定了一氧化碳弥散量(DLCO)。数据以标准差(SD)评分表示。定义了四种呼吸功能异常模式:限制性、阻塞性、孤立性细支气管损伤、孤立性弥散损伤。
12例患者(44%)无症状,肺功能测试完全正常。3例患者报告运动时呼吸困难,其中1例还伴有咳嗽和咳痰:在这些有症状的受试者中只有1例存在功能异常(孤立性DLCO损伤)。5例患者(18%)出现限制性模式,其中2例的DLCO SD评分也异常。另外8例患者(30%)存在孤立性弥散损伤。所有患者的血氧饱和度均正常。DLCO正常的患者中47%接受了较低剂量的照射(20 Gy),而DLCO受损的患者中这一比例为10%(P = 0.054)。同样,与DLCO异常的患者相比,DLCO正常的患者接受的化疗明显更少(P = 0.003)。肺部异常的发生与性别、治疗时的年龄、纵隔照射以及治疗结束后的时间无显著相关性。
接受儿童HD治疗的青少年和年轻成年人存在肺功能异常的风险,在接受更强化治疗的患者中更为常见,如更高剂量(> 20 Gy) 的纵隔照射和更多疗程的化疗。由于这些患者的肺功能潜力可能有限,且对烟雾、污染、感染和衰老等不良因素的抵抗力可能较低,因此应给予他们长期随访。