Abstract
PurposeTo report the treatment results and prognostic factors of childhood patients with Hodgkin's disease treated with chemotherapy (CT) followed by low dose radiotherapy (RT).Patients and methodsThis retrospective series analyzed 166 patients under 18 years old, treated from January 1985 to December 2003. Median age was 10 years (range 2–18). The male to female ratio was 2,3 : 1. Lymphonode enlargement was the most frequent clinical manifestation (68%), and the time of symptom duration was less than 6 months in 55% of the patients. In histological analysis Nodular Sclerosis was the most prevalent type (48%) followed by Mixed Celularity (34.6%). The staging group according Ann Arbor classification was: I (11.7%), II (36.4%), III (32.1%) and IV (19.8%). The standard treatment consisted of chemotherapy multiple drug combination according the period of treatment protocols vigent: ABVD in 39% (n-65) of the cases, by VEEP in 13 %(n-22), MOPP in 13 %(n-22), OPPA-13 %(n-22) and ABVD/OPPA in 22 %(n-33). Radiotherapy was device to all areas of initial presentation of disease. Dose less or equal than 21 Gy was used in 90.2% of patients with most part of them (90%) by involved field (IFRT) or mantle field.ResultsThe OS and EFS in 10 years were 89% and 87%. Survival according to clinical stage as 94.7%, 91.3%, 82.3% and 71% for stages I to IV(p = 0,005). The OS was in 91.3% of patients who received RT and in 72.6% of patients who did not (p = 0,003). Multivariate analysis showed presence of B symptoms, no radiotherapy and advanced clinical stage to be associated with a worse prognosis.ConclusionThis data demonstrating the importance of RT consolidation with low dose and reduced volume, in all clinical stage of childhood HD, producing satisfactory ten years OS and EFS. As the disease is highly curable, any data of long term follow-up should be presented in order to better direct therapy, and to identify groups of patients who would not benefit from radiation treatment.
Highlights
During the last two decades, treatment strategies of pediatric Hodgkin's disease have changed considerably
This data demonstrating the importance of radiation therapy (RT) consolidation with low dose and reduced volume, in all clinical stage of childhood HD, producing satisfactory ten years Overall Survival (OS) and event free survival (EFS)
As the disease is highly curable, any data of long term follow-up should be presented in order to better direct therapy, and to identify groups of patients who would not benefit from radiation treatment
Summary
During the last two decades, treatment strategies of pediatric Hodgkin's disease have changed considerably. Combined chemotherapy and radiotherapy regimens have become the standard approach because they allow one to reduce toxicity while maintaining high overall efficacy. In these regimens, chemotherapy as well as radiotherapy is adapted according to stage, spread and volume of disease [6,7,8,9,10,11,12,13]. Risk-adapted regimens seek to maintain disease control while reducing therapy-related complications. This approach may reduce therapy for patients with favourable diagnostic features or intensify therapy for patients with unfavourable disease presentations. In this study we analyze a single institution's experience of 15 years on the treatment of childhood Hodgkin's disease
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