Hodgkin's disease in children. Results of management between 1970-1981.

Abstract

Between May 1970 and April 1981, 108 previously untreated children, ages four to 20 years (median, 11 years) with Hodgkin-s disease (HD) had been treated at Memorial Sloan-Kettering Cancer Center (MSKCC). In addition to the clinical and biochemical diagnostic procedures, surgical staging was done on all but three patients. Most children with pathologic stages (PS) I and II received involved field (IF) irradiation. Of 34 PS IA and IIA patients so treated, 26 are relapse-free for 1–10+ years (median, 5+ years). Eight patients had relapses 5–23 months (median, 9 1/2 months) after completion of radiation. All but one are currently disease-free after retreatment including chemotherapy. Initially, total nodal irradiation (TNI) was given to PS III patients, but six of seven of these developed relapses within four years of treatment. Also three of eight patients with PS IB and IIB treated by local irradiation had relapses all within 13 months after radiotherapy. For Stage IV disease a sequential multiple drug chemotherapy protocol (MDP) consisting of six cycles of Adriamycin, vincristine, prednisone, and procarbazine followed by cyclophosphamide were used in conjunction with IF irradiation to bulky disease areas. Since 1974, all patients with constitutional (“B”) symptoms and those of PS III and IV have been treated first with three cycles of MDP chemotherapy, followed by IF irradiation to disease area and three more cycles of MDP chemotherapy. The first ten patients so treated received 3600 to 4000 rad of radiation and all are disease-free 3+ to 7+ years (median, 6+ years) after completion of therapy. Subsequently, the dose of radiation was reduced to 2400 and 2000 rad for Stage III and Stage IV patients, respectively. Of 30 patients so treated, 27 are relapse-free, (median, 25 months). Eleven other patients received chemotherapy alone, and three had relapses. Their risk of recurrence was significantly higher than those who received combined chemotherapy and radiotherapy (P <0.02). The ten year relapse-free and survival rate of the whole group is 76% and 84%, respectively. Involved field irradiation for PS IA and IIA patients and combined MDP chemotherapy with low-dose IF irradiation for other patients are the recommended treatment of choice for children with HD. Staging laparotomy remains a useful procedure for the treatment planning of these patients.