Response-adapted de-escalation of radiotherapy in pediatric Hodgkin's lymphoma

Pediatric Hodgkin's lymphoma has a very high cure rate; hence, there is a major focus on minimizing radiation therapy. This study examined the impact of omitting radiotherapy (RT) on patients with rapid early response (RER) and minimizing RT on patients with slow early response (SER). This study included all pediatric Hodgkin's lymphoma patients who were treated with a response-adapted approach (study group). They were compared to a historical cohort who received their treatment with both chemotherapy and classic involved field radiotherapy to all patients regardless of the response (control group). Patients with RER in both groups had excellent OS (100%), and comparable EFS (p = 0.556). Moreover, patients with SER in the two groups showed similar OS (p = 0.646) and EFS (p = 0.699). Omission of RTH may be considered in patients with RER; moreover, in patients with SER, minimizing RTH was not associated with inferior outcome in our study.