title: [Can children with Hodgkin's disease be treated with chemotherapy only?].
abstract: Currently over 90% of children and adolescents with Hodgkin's disease (HD) can be cured thanks to use of multidrug chemotherapy (CT) combined with involved-field radiotherapy (IF-RT). However, the intensive treatment may increase the risk of late complications which may impair the patients' quality of life. In order to decrease the incidence of late complications the protocol with limited use of IF-RT was introduced in centers of Polish Pediatric Leukemia/Lymphoma Study Group (PPLLSG). This study presents the treatment results of patients treated with CT only in comparison with the therapy results of children treated with CT and IF-RT. From 1997 to 2006, 634 children (age: 2-22,5 years) with HD were treated in 14 oncological centers of PPLLSG. Majority of patients received CT (3-8 cycles of MVPP/B-DOPA) combined with IF-RT. In 45 patients with IA-IIA stages presenting favorable risk factors (small mediastinal tumor, peripheral nodular mass of a maximum diameter < 6 cm, involvement of less than three nodular regions, ESR < 50 mm after 1 h, histologic type other than lymphocyte depletion and very good treatment response assessed after 3 CT cycles) IF-RT was omitted. Among 634 children first complete remission (RC) was not achieved in 2.4% of patients. Relapses occurred in 24 children (3.9%). The rates of 5-year overall survival (OS), relapse-free survival (RFS) and event-free survival (EFS) were 97%, 96% i 92%, respectively. All patients treated with CT only remain in first CR. All serious late complications (including 7 second neoplasms) occurred in patients treated with CT combined with RT. Seven children died because of severe complications, among them two in first CR (aplastic anemia, sepsis). Our results show that the use of CT only in precisely selected group of patients with HD do not impair the treatment results and may decrease the risk of late life threatening complications. Treatment response assessment with the use of PET may in future increase the number of patients treated without RT and limit the need of the use of invasive diagnostic methods in patients with residual mass.
authors.affiliation: Klinika Onkologii i Hematologii Dzieciecej, PA Instytut Pediatrii UJ CM, Kraków. balwierz@mp.pl
authors.forename: Walentyna
authors.initials: W
authors.lastname: Balwierz
authors.forename: Tomasz
authors.initials: T
authors.lastname: Klekawka
authors.forename: Angelina
authors.initials: A
authors.lastname: Moryl-Bujakowska
authors.forename: Michał
authors.initials: M
authors.lastname: Matysiak
authors.forename: Barbara
authors.initials: B
authors.lastname: Sopyło
authors.forename: Jacek
authors.initials: J
authors.lastname: Wachowiak
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Kaczmarek-Kanold
authors.forename: Danuta
authors.initials: D
authors.lastname: Sońta-Jakimczyk
authors.forename: Anna
authors.initials: A
authors.lastname: Janik-Moszant
authors.forename: Alicja
authors.initials: A
authors.lastname: Chybicka
authors.forename: Robert
authors.initials: R
authors.lastname: Chaber
authors.forename: Jerzy R
authors.initials: JR
authors.lastname: Kowalczyk
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Mitura-Lesiuk
authors.forename: Anna
authors.initials: A
authors.lastname: Balcerska
authors.forename: Teresa
authors.initials: T
authors.lastname: Stachowicz-Stencel
authors.forename: Mariusz
authors.initials: M
authors.lastname: Wysocki
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kołtan
authors.forename: Maryna
authors.initials: M
authors.lastname: Krawczuk-Rybak
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Muszyńska-Rosłan
authors.forename: Wojciech
authors.initials: W
authors.lastname: Młynarski
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Stolarska
authors.forename: Grazyna
authors.initials: G
authors.lastname: Sobol
authors.forename: Maria
authors.initials: M
authors.lastname: Wieczorek
authors.forename: Grazyna
authors.initials: G
authors.lastname: Karolczyk
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Urbanek-Dadela
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D055815:Young Adult