title: Treatment of children and adolescents with Hodgkin lymphoma without radiotherapy for patients in complete remission after chemotherapy: final results of the multinational trial GPOH-HD95.
abstract: PURPOSE To minimize the risk of late effects in pediatric Hodgkin lymphoma (HL) by omitting radiotherapy (RT) in patients in complete remission (CR) after chemotherapy and reducing the standard radiation dose to 20 Gy in patients in incomplete remission.
  
  
  METHODS
  Between 1995 and 2001, 925 patients with classical HL (cHL) were registered from seven European countries in German Society of Pediatric Oncology and Hematology Hodgkin Lymphoma Trial 95. Patients in treatment group 1 (TG1; early stages) received two cycles of vincristine, prednisone, procarbazine, and doxorubicin or vincristine, prednisone, etoposide, and doxorubicin chemotherapy; additional two or four cycles of cyclophosphamide, vincristine, prednisone, and procarbazine were added in TG2 (intermediate stages) or TG3 (advanced stages), respectively. Patients in CR (assessed by computed tomography or magnetic resonance imaging) did not undergo RT. Those with tumor volume reduction more than 75% received reduced involved-field RT with 20 Gy and an additional 10- or 15-Gy boost only for larger residuals.
  
  
  RESULTS
  Rates of overall survival, progression-free survival (PFS), and event-free survival at 10 years were (± SE) 96.3% ± 0.6%, 88.2% ± 1.1%, and 85.4% ± 1.3%, respectively. PFS for TG1 patients without or with RT was 97.0% ± 2.1% versus 92.2% ± 1.7% (P = .214) but was unsatisfactory for nonirradiated patients in TG2 (68.5% ± 7.4% v 91.4% ± 1.9%; P < .0001), with similar but not significant results in TG3 (82.6% ± 5.4% v 88.7% ± 2.0%, P = .259). Reduction of the standard radiation dose from 25 to 20 Gy did not increase failure rate.
  
  
  CONCLUSIONS
  RT can be omitted in early stage HL in so defined CR following this chemotherapy. RT with 20(-35) Gy proved to be sufficient in patients with incomplete remission following chemotherapy.
authors.affiliation: Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch, Germany. wolfgang.doerffel@helios-kliniken.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dörffel
authors.forename: Ursula
authors.initials: U
authors.lastname: Rühl
authors.forename: Heike
authors.initials: H
authors.lastname: Lüders
authors.forename: Alexander
authors.initials: A
authors.lastname: Claviez
authors.forename: Marion
authors.initials: M
authors.lastname: Albrecht
authors.forename: Jos
authors.initials: J
authors.lastname: Bökkerink
authors.forename: Harald
authors.initials: H
authors.lastname: Holte
authors.forename: Jonas
authors.initials: J
authors.lastname: Karlen
authors.forename: Georg
authors.initials: G
authors.lastname: Mann
authors.forename: Heinz
authors.initials: H
authors.lastname: Marciniak
authors.forename: Felix
authors.initials: F
authors.lastname: Niggli
authors.forename: Kjeld
authors.initials: K
authors.lastname: Schmiegelow
authors.forename: Ernst-Wilhelm
authors.initials: EW
authors.lastname: Schwarze
authors.forename: Richard
authors.initials: R
authors.lastname: Pötter
authors.forename: Lutz
authors.initials: L
authors.lastname: Wickmann
authors.forename: Günther
authors.initials: G
authors.lastname: Schellong
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D007390:International Agencies; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D011344:Procarbazine; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine; D011241:Prednisone