Pediatric Hodgkin Lymphoma, the Rationale for Radiation Therapy

Abstract

The challenge in pediatric Hodgkin lymphoma (HL) is to continue progress in its curability while diminishing the risk for delayed toxicities that has undermined this progress. Pediatric HL is highly curable, with a 10-year actuarial survival rate of 85–97% in early-stage disease, and 70–90% in advanced-stage disease. The most profound morbidities that prompted trials of combined chemotherapy and low-dose radiation therapy (RT) were musculoskeletal and soft tissue growth impairment, as well as delayed myocardial failure or infertility from commonly used chemotherapy agents. Contemporary pediatric HL treatment employs multiagent chemotherapy, with dose intensity tailored according to patients’ risk factors, and selected use of low-dose radiation therapy to lymph node regions initially involved (i.e., involved-field radiation therapy, IFRT). The goal is to refine therapy in a rare disease in which long-time intervals are necessary to observe an adequate number of events (treatment failure or late effects) to answer judicious questions.