title: The impact of central review and central therapy planning on the treatment of children and adolescents with Hodgkin lymphoma.
abstract: OBJECTIVE
  The multicentre response-adapted paediatric Hodgkin lymphoma trial GPOH-HD95 (1995-2001, 925 patients) was followed by the 'HD-Interval' period (2001-2002, 203 patients). During this period, treatment was recommended according to GPOH-HD95 protocol with only minor changes. Central review and treatment planning as in HD95, however, had to be omitted in the absence of funding. Results of both periods were compared to evaluate the impact of central review on staging, stratification, treatment planning and outcome.
  
  
  METHODS
  Pre- and post-chemotherapy computed tomography and magnetic resonance imaging of HD-Interval patients were evaluated with respect to reliability of staging, response assessment and subsequent treatment stratification.
  
  
  RESULTS
  Despite more favourable patient characteristics and treatment group stratifications, the 10-year progression-free survival (PFS) was inferior in HD-Interval patients compared to GPOH-HD95 patients with nearly identical therapy (86% versus 91%, P=0.01). Of 142 patients without guidance by the reference centre, 56 (39%) received a treatment deviating from protocol recommendations: chemotherapy doses were either lower or higher than recommended in 17% of patients, and deviations concerning radiotherapy dose and treatment volume occurred in 25% and 20%, respectively. In both periods, the 10-year PFS was lower in patients with diminished therapy compared to those with adequate treatment according to the given recommendations (HD-Interval: 72% versus 89%, P=0.02; GPOH-HD95: 80% versus 92%, P=0.04).
  
  
  CONCLUSIONS
  Deviations from protocol treatment may influence negatively the outcome in paediatric oncology. Protocol enrolment and compliance including timely and correct treatment are crucial. Central reference and consultation centres offer quality assurance, support protocol adherence, and hence influence PFS.
authors.affiliation: Evangelische Lungenklinik Berlin, Germany. Electronic address: heike.lueders@elk-berlin.de.
authors.forename: Heike
authors.initials: H
authors.lastname: Lüders
authors.affiliation: VIVANTES Klinikum Berlin-Moabit, Klinik für Radioonkologie, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Rühl
authors.affiliation: HELIOS Klinikum Berlin-Buch, Institut für Röntgendiagnostik, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Marciniak
authors.affiliation: Universitätsklinikum Halle (Saale), Institut für Medizinische Epidemiologie, Biometrie und Informatik, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Haerting
authors.affiliation: Klinik für Allgemeine Pädiatrie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Claviez
authors.affiliation: St. Anna Kinderspital Wien, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Mann
authors.affiliation: Universitätsklinikum Münster, Klinik für Kinder- und Jugendmedizin, Pädiatrische Onkologie und Hämatologie, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Schellong
authors.affiliation: HELIOS Klinikum Berlin-Buch, Klinik für Kinder- und Jugendmedizin, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Wickmann
authors.affiliation: HELIOS Klinikum Berlin-Buch, Klinik für Kinder- und Jugendmedizin, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dörffel
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000379:methods; D002648:Child; D026661:Clinical Trials Data Monitoring Committees / Q000592:standards; D018572:Disease-Free Survival; D005260:Female; D006689:Hodgkin Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012107:Research Design / Q000592:standards; D014057:Tomography, X-Ray Computed
keywords: Central review; Hodgkin lymphoma; Paediatric; Reference centre