An evaluation of abdominal staging procedures performed in pediatric patients with advanced Hodgkin's disease: a report from the Childrens Cancer Study Group.
Forty-nine children and adolescents underwent staging laparotomy in the course of a cooperative group (CCG) study of advanced Hodgkin's disease (HD). The purpose of the study was to evaluate the toxicity of a regimen of 12 cycles of doxorubicin, bleomycin, vinblastine, and imidazole carboxamide (ABVD) plus 2,100 cGy regional irradiation in patients with stage III-IV disease. Review of the biopsies and specimens from these 49 laparotomies identified distinct patterns of abdominal involvement and permitted an evaluation of the importance of different aspects of the staging procedure and an assessment of the value of non-invasive techniques in determining the extent of abdominal disease. The major observations from these studies were: (1) computed tomography (CT) and gallium 67 scans (GA) were specific (few false positives), but not sensitive, indicators of abdominal disease; (2) negative findings at laparotomy in 29 patients permitted a contraction of the abdominal radiation fields with no subsequent abdominal recurrence in these patients; (3) in five patients, stage IV status was established only by laparotomy and open hepatic biopsy; (4) all patients with lower abdominal or pelvic involvement also had upper abdominal node or splenic involvement; (5) involvement of splenic hilar nodes was a sensitive predictor of splenic involvement; (6) disease in the inferior paraaortic nodes accurately predicted the presence of more distal disease, ie, in the iliac or pelvic node groups; and (7) in a limited experience, transposition of the ovaries protected ovarian function from the effects of pelvic irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)
Hays
D M
DM
University of Southern California School of Medicine, Los Angeles.
Fryer
C J
CJ
Pringle
K C
KC
Collins
R D
RD
Hutchinson
R J
RJ
O'Neill
J A
JA
Constine
L S
LS
Heller
R M
RM
Davis
P C
PC
Nachman
J
J
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D005710:Gallium Radioisotopes; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D011183:Postoperative Complications; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013154:Spleen / Q000473:pathology; D014057:Tomography, X-Ray Computed
D005710:Gallium Radioisotopes