Treatment of pediatric Hodgkin disease avoiding radiotherapy: excellent outcome with the Rotterdam-HD-84-protocol.
BACKGROUND
To reduce radiotherapy (XRT) induced toxicity of treatment of children with Hodgkin disease (HD) while maintaining a high cure rate, we introduced a risk-adapted protocol consisting of chemotherapy (CT) alone in 1984.


METHODS
The outcome of 46 children treated for HD from 1984 until 2000 according to the Rotterdam-HD-84-protocol was determined. Children with stage I-IIA disease (n = 23), were treated with six courses of epirubicin, bleomycin, vinblastine, and dacarbazine (EBVD). Children with stage IIB-IV disease (n = 23), were treated with three to five alternating cycles of EBVD and mechlorethamine, vincristine, procarbazine, and prednisone (MOPP).


RESULTS
At a median follow-up time of 8.6 years (range 2.6-18.3 years), the 10-year overall survival (OS) is 95% and the event-free survival (EFS) 91%. In 5/46 patients XRT was administered because of residual mediastinal mass. Four children relapsed, two of them died. Up until now only one patient developed hypothyroidism; no symptomatic cardiac or pulmonary dysfunction, no second malignancy has been diagnosed.


CONCLUSIONS
Risk-adapted treatment consisting of CT alone is highly efficacious for children with HD and toxicity is low. XRT was administered in only a small minority of children with HD. CT should be the first choice for HD in children and XRT should preferably be used for those with refractory or histologically proven residual disease or relapse.
Hakvoort-Cammel
Friederike G A J
FG
Department of Pediatric Oncology and Hematology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. f.hakvoort@erasmusmc.nl
Buitendijk
Saskia
S
van den Heuvel-Eibrink
Marry
M
Hählen
Karel
K
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001761:Bleomycin / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003606:Dacarbazine / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008466:Mechlorethamine / Q000009:adverse effects / Q000627:therapeutic use*; D009426:Netherlands / Q000453:epidemiology; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D011344:Procarbazine / Q000009:adverse effects / Q000627:therapeutic use*; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014747:Vinblastine / Q000009:adverse effects / Q000627:therapeutic use*; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use*
D001761:Bleomycin; D011344:Procarbazine; D015251:Epirubicin; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D011241:Prednisone