The changing management of childhood Hodgkin's disease

Between 1929 and September 1974, 211 children under 15 years of age with biopsy-proven Hodgkin's disease were treated at Memorial Sloan-Kettering Cancer Center. For analysis these patients were placed into three historical groups which displayed the most marked changes in diagnostic workup and therapy. They are as follows: Pre-1959-80 patients with "clinical" staging, local field radiation therapy, palliative chemotherapy; 1960-1969-86 patients with lymphangiographic staging, extended field radiation therapy, palliative chemotherapy; 1970-September 1974-45 patients with "contemporary" staging, including laparotomy, involved field radiation therapy, and/or multiple drug chemotherapy. Twenty-seven children with Stage IV disease at diagnosis or those with recurrent disease received this multiple drug regimen. This consisted of Adriamycin, followed by combined prednisone, procarbazine, and vincristine, then cyclophosphamide. Drug cycles were repeated every 3-4 months for a period of about 24 months. Twenty-five achieved remission, 20 complete and 5 partial. The median duration of complete remission was 18 plus months. This multidisciplinary management of Hodgkin's disease has shown early, encouraging results. Longer followup is needed to determine that this improvement in survival will persist into adulthood.