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目的:通过评估高危霍奇金淋巴瘤(HL)低龄患儿高强度诱导化疗对巩固放疗的影响,探讨诱导化疗药物的安全性及巩固放疗的有效实施方法。方法:对6例高危HL患儿,采用阿糖胞苷+依托泊苷(Ara-C/VP16)、阿霉素+博来霉素+长春新碱+依托泊苷+泼尼松+环磷酰胺(ABVE-PC)和环磷酰胺+长春新碱+阿霉素+强的松(CHOP)3种化疗方案交替高强度化疗6周期后,应用容积旋转调强放疗(VMAT)技术给予低剂量受累野照射(IFRT)。评估治疗后的疗效和不良反应。结果:低龄患儿对高强度诱导化疗和巩固放疗耐受好,放疗急性/亚急性的不良反应轻微。高强度诱导化疗药物未增加巩固放疗的不良反应。该诱导化疗方案中,肺毒性药物博来霉素累积剂量为20 mg/m2,心脏毒性药物阿霉素累积剂量为270 mg/m2。巩固放疗中VMAT技术可保证危及器官的受量安全,进行纵隔照射的患儿肺平均受量为525.6c Gy,心脏平均受量为503.9c Gy。结论:高危HL低龄患儿放疗前诱导化疗给予Ara-C/VP16、ABVE-PC和CHOP方案交替6周期相对安全,巩固放疗给予18~20 Gy、局部加量至20~25Gy、分次剂量在1.5~1.8Gy的IFRT操作可行,并且建议采用VAMT技术。
OBJECTIVE: To evaluate the effect of high-intensity induction chemotherapy on radiation therapy in young children with high-risk Hodgkin’s lymphoma (HL) and evaluate the safety of induction chemotherapy and the effective ways to consolidate radiotherapy. Methods: Six children with high-risk HL were treated with Ara-C / VP16, doxorubicin + bleomycin + vincristine + etoposide + prednisone + After six cycles of alternating high-intensity chemotherapy with amiodarone (ABVE-PC) and cyclophosphamide + vincristine + doxorubicin + prednisone (CHOP), low-dose Involved field exposure (IFRT). Evaluate the efficacy and adverse reactions after treatment. Results: Young children with high-intensity induction chemotherapy and consolidation of radiation well tolerated radiotherapy acute / subacute adverse reactions minor. High-intensity induction of chemotherapy drugs did not increase the adverse reactions of consolidation radiotherapy. In the induction chemotherapy regimen, the cumulative dose of bleomycin, a pulmonary toxic drug, was 20 mg / m2 and the cumulative dose of the cardiotoxic drug, adriamycin, was 270 mg / m2. Consolidation of the radiotherapy VMAT technology can guarantee the endangerment of organ safety, the average lung volume in children with mediastinal irradiation is 525.6 c Gy, and the average heart volume is 503.9 c Gy. Conclusions: Ara-C / VP16 is given by induction chemotherapy before radiotherapy in children with high-risk HL. The 6 cycles of ABVE-PC and CHOP are relatively safe, 18-20 Gy of consolidation radiotherapy are given, and the local dosage is 20-25 Gy. 1.5 ~ 1.8Gy IFRT operation is feasible, and recommended the use of VAMT technology.