title: Patterns of treatment failure in pediatric and young adult patients with Hodgkin's disease: local disease control with combined-modality therapy.
abstract: OBJECTIVE
  Refinement in managing pediatric Hodgkin's disease (HD) requires understanding of factors associated with local treatment failure. This study defines the cumulative incidence (CI) of local failure (LF) and prognostic factors for pediatric patients treated for HD with combined-modality therapy (CMT).
  
  
  METHODS
  We enrolled 195 patients onto two prospective studies at St Jude Children's Research Hospital between 1990 and 2000. Patients received CMT with chemotherapy (vinblastine, doxorubicin, methotrexate, and prednisone [VAMP]; vinblastine, etoposide, prednisone, and doxorubicin; or VAMP/cyclophosphamide, vincristine, and procarbazine) and involved-field radiation therapy delivered to initial site(s) of disease on the basis of early response. Sites of disease involvement, treatment, and sites of failure were confirmed from the patients' medical record, imaging, and radiotherapy treatment records. We estimated the overall survival, event-free survival, and CI of LF.
  
  
  RESULTS
  With a median follow-up of 7.6 years, the CI of LF was 10.9% and 11.6% at 5 and 10 years, respectively. Twenty-seven (14%) of 195 patients experienced recurrence of HD, and 22 (81%) of those experienced LF. Bulky mediastinal disease greater than one third transthoracic diameter predicted a higher incidence of LF, but did not predict failure in the mediastinum. Male sex, low initial hemoglobin, and bulky mediastinal disease were prognostic indicators of LF. Attenuation of radiation dose to 15 Gy based on response provides excellent infield control.
  
  
  CONCLUSIONS
  CMT provides excellent local disease control in children and young adults with HD. LF remains a primary site of disease recurrence, with male sex, low initial hemoglobin, and bulky mediastinal disease predicting for LF.
authors.affiliation: Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, TN 38105, USA. Matthew.Krasin@stjude.org
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Krasin
authors.forename: Shesh N
authors.initials: SN
authors.lastname: Rai
authors.forename: Larry E
authors.initials: LE
authors.lastname: Kun
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.forename: Monika L
authors.initials: ML
authors.lastname: Metzger
authors.forename: Sue C
authors.initials: SC
authors.lastname: Kaste
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006689:Hodgkin Disease / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D013714:Tennessee / Q000453:epidemiology; D017211:Treatment Failure