Treatment of advanced Hodgkin's disease in pediatric patients

From 1970 to 1976, twenty patients with stage II E or II B to IV B Hodgkin's disease were treated at Children's Hospital of Philadelphia. Initially, four of the stage II or III patients received planned total nodal irradiation (TNI) alone; three patients developed progressive disease during irradiation, and one relapsed after 18 months. These results with TNI led to the use of combined modality therapy. Sixteen patients (4, stage II E or B; 8, stage III; 4, stage IV) were treated with COPP (cyclophosphamide, Oncovin, prednisone, and procarbazine) and radiation therapy. In 14 patients treatment was started with COPP. Patients with disease below L2 received TNI; the rest received involved field (IF) or extended field (EF) irradiation. No patient treated with combination therapy encountered life-threatening toxicity. Relapse-free survival in 12 stage II or III patients is 100% with a median follow-up of 28 months (range, 24 to 91 months). Only one of four stage IV patients is alive. Combined modality therapy is effective, tolerable therapy for children with stage II B--III Hodgkin's disease. No relapses occurred in 10 patients given less that potentially curative radiation. Smaller radiation fields and lower doses are planned for the future.