Doença de Hodgkin: análise do protocolo DH-II-90 / Hodgkins disease: the protocol DH-II-90

AUTOR(ES)
DATA DE PUBLICAÇÃO

2010

RESUMO

The treatment of Hodgkin´s disease (HD) has been increasingly successful lately. Since today cure rates are about 85%, the challenge of new protocols for treatment of HD is to decrease its aggressiveness and consequent acute and late toxicity, without impairing results. The protocol DH-II-90 was designed to treat children and adolescents with HD. It consists of three cycles of ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine) and involved-field radiotherapy for low risk patients, and incremented with three cycles of MOP (mechlorethamine, vincristine and prednisone) or COP (replacing mechlorethamine by cyclophosfamide) and extended field radiotherapy for high risk patients. Objectives: the purposes of this study are 1) to assess the overall, disease free and event free survival of the protocol DH-II-90, 2) to assess the overall and event free survival by stage, age, presence of bulky disease, mediastinal mass, B symptoms, dose and type of radiotherapy, and 3) to describe late effects data collected from the patients´charts. Methods: This is a retrospective study to assess archive of patients with HD, with 0 to 21 years old, admitted to the pediatric oncology service of the Instituto da Criança da FMUSP diagnosed between 1990 and 2005 and treated with the protocol DH-II-90. Overall, disease free and event free survival curves were developed by the Kaplan-Meier method and analyzed with the Cox regression. A significant level of 5% (p<0.05) was employed. The clinical and laboratorial data of these patients are described, completing a profile of 15 year of experience. Results: The complete response rate after chemotherapy was 94.1% for all the group, 97.3% for the low risk patients and 90% for the high risk patients. The overall survival in 10 years was 96% for the low risk group and 93% for the high risk group. The 5- years disease free survival was 90%. Disease free survival for high risk patients was worse than low risk group (87% and 92% respectively), but it was not statistically significant (p: 0.486). The 5-year event free survival was 90%, with similar curves for low and high risk patients (p: 0.969). The presence of mediastinal mass and more than 2100 cGy radiation doses had negative impact on event free survival (p= 0.020 and p= 0.014 respectively). Thyroid gland dysfunction was the most frequent late effect described, with two cases of thyroid carcinoma as a secondary neoplasia. Conclusions: The DH-II-90 protocol is effective , while the presence of mediastinal mass and radiation dose over 2100 cGy have a negative impact on event free survival. Thyroid abnormalities are the most frequent late effects in this group of patients.

ASSUNTO(S)

criança doença de hodgkin/quimioterapia doença de hodgkin/radioterapia prognóstico hodgkins disease/radiotherapy children prognosis hodgkins disease/chemotherapy

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