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A Protocol for Rapid Post-mortem Cell Culture of Diffuse Intrinsic Pontine Glioma (DIPG)
Published on: March 7, 2017
Pediatric Hodgkin's disease
B Oliapuram Jose1, Paul Koerner, Salvatore Bertolone
1Departments of Radiation Oncology and Pediatrics (Division of Pediatric Hematology and Oncology), James Graham Brown Cancer Center, University of Louisville School of Medicine, 529 South Jackson Street, Louisville, KY 40202, USA.
Insights
This study on pediatric Hodgkin's lymphoma shows excellent outcomes for early-stage disease treated with radiation and chemotherapy. Advanced stages require further investigation for improved survival rates.
Area of Science:
- Oncology
- Pediatric Hematology-Oncology
- Radiation Oncology
Background:
- Hodgkin's lymphoma (HL) is a significant malignancy in pediatric populations.
- Understanding treatment patterns and outcomes is crucial for improving patient care.
- This study reviews a cohort of pediatric HL patients treated between 1981-1992.
Purpose of the Study:
- To analyze the treatment modalities and outcomes of pediatric Hodgkin's lymphoma patients.
- To evaluate the efficacy of radiation therapy and combination chemotherapy in different stages of the disease.
- To identify prognostic factors and long-term survival in this cohort.
Main Methods:
- Retrospective review of 32 pediatric Hodgkin's lymphoma patients treated from 1981-1992.
- Analysis of patient demographics, disease staging (Ann Arbor staging), histopathology, treatment regimens (radiation alone vs. chemotherapy combinations like ABVD/MOPP), and radiation doses.
- Evaluation of treatment outcomes including survival and disease recurrence.
Main Results:
- The median age of patients was 14 years, with a predominance of males (72%) and white ethnicity (97%).
- Common sites of involvement included the neck (84%) and mediastinum (66%). Nodular sclerosing type was most frequent (78%).
- All patients in Stages I and II survived without evidence of disease. One Stage III patient died from a secondary primitive neuroectodermal tumor, and one Stage IV patient died from Hodgkin's disease.
Conclusions:
- Early-stage pediatric Hodgkin's lymphoma demonstrates high survival rates with current treatment protocols.
- Combination chemotherapy and radiation therapy are effective, but long-term surveillance for secondary malignancies is warranted.
- Further research is needed to optimize treatment for advanced-stage disease to improve outcomes.
Abstract:
Thirty-two patients were treated in this Department from 1981-1992. The median age was 14 years (range 4 years to 17 years). There are 6 patients (19%) below the age of 10 years, 16 patients (50%) between 11 years to 15 years, and 10 patients (31%) above 16 years. Twenty-three patients (72%) are male and 9 patients (28%) are female. Thirty-one patients (97%) are white, and 1 patient (3%) is Afro-American. The stages of the patients are: Stage I--7 patients, Stage II--12 patients, Stage III--9 patients, and Stage IV--4 patients. Twenty-one patients (66%) in the early period of the study were staged surgically by staging laparotomy. The most common sites are: neck (84%), mediastinum (66%), and para-aortic lymph nodes (22%). Twenty-five patients (78%) have nodular sclerosing type, 5 patients (16%) have mixed cellularity, and 2 patients (6%) have lymphocytic predominant type. Eight patients (25%) were treated with radiation alone and 24 patients (75%) were treated with a combination of chemotherapy and radiation. Of the radiation group, 5 patients were treated with mantle field; 2 patients with mantle, para-aortic node and splenic pedicles; and 1 patient with mini-mantle field. The treatment was given with 4 or 6 mv photon, and the median dose was 36 Gray (range 32-40 Gy). Of the combination group, 11 patients were treated with ABVD (doxorubicin + bleomycin + vinbastine + dacarbazine), 10 patients with ABVD/MOPP (MOPP: mechlorethamine + vincristine + procarbazine + prednisone) and 3 patients with MOPP alone. The median irradiation dose in the combination group was 25 Gy (range 21 Gy-36 Gy). All the patients in this group were treated to the involved site with custom blocks. Three patients were lost for follow-up because of transfers out-of-state and could not be located. All patients in Stages I and II are alive without any evidence of disease at the last follow-up. One patient with Stage III disease developed a second cancer (PNET: primitive neuroectodermal tumor) 111 months after combination treatment and has died. One Stage IV patient has died with Hodgkin's disease 28 months after treatment with combination therapy. All other patients are followed closely along with the primary physicians and consultants.
