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Pediatric stage IV Hodgkin disease. Long-term survival
S B Bader1, H Weinstein, P Mauch
1Joint Center for Radiation Therapy, Harvard Medical School, Boston, MA.
Insights
Combined-modality therapy (CMT), including chemotherapy and radiation therapy (RT), significantly improved freedom from progression (FFP) in children with Stage IVB Hodgkin disease (HD). This approach is favored over chemotherapy alone for advanced HD treatment.
Area of Science:
- Pediatric Oncology
- Hematology
- Radiation Oncology
Background:
- Optimal treatment for Stage IV Hodgkin disease (HD) is uncertain, especially the role of radiation therapy (RT).
- Hodgkin disease is a cancer of the lymphatic system.
- Stage IV HD indicates widespread disease.
Purpose of the Study:
- To evaluate the effectiveness of combined-modality therapy (CMT) versus chemotherapy (CT) alone in treating pediatric Stage IV Hodgkin disease.
- To determine if adding radiation therapy (RT) to chemotherapy improves outcomes in advanced HD.
- To analyze progression-free survival (PFS) and overall survival (OS) rates.
Main Methods:
- Retrospective review of 43 children (≤18 years) with Stage IV HD treated between 1970 and 1988.
- All patients received combination chemotherapy (MOPP or MOPP plus other agents).
- 20 patients received adjuvant radiation therapy (RT) after chemotherapy, forming the combined-modality therapy (CMT) group.
Main Results:
- Seven-year actuarial freedom from progression (FFP) was 69% and survival was 78% for all patients.
- Combined-modality therapy (CMT) significantly improved progression-free survival for patients with Stage IVB HD compared to CT alone (2 relapses vs. 8 relapses; P=0.003).
- Patients achieving complete response (CR) to CT had better survival rates than those with partial response (PR), though not statistically significant.
Conclusions:
- Combined-modality therapy (CMT), incorporating chemotherapy and radiation therapy (RT), demonstrated a significant benefit in freedom from progression for Stage IVB Hodgkin disease.
- The addition of RT to chemotherapy appears crucial for improving outcomes in advanced pediatric Hodgkin disease, particularly for Stage IVB.
- This retrospective analysis supports the use of CMT for Stage IVB HD.
Background:
The optimal treatment for Stage IV Hodgkin disease (HD) remains uncertain, particularly the role of radiation therapy (RT).
Methods:
A retrospective review of 43 children, 18 years of age or younger, who were seen and treated for Stage IV HD between June 1970 and June 1988, was performed. All patients were treated with combination chemotherapy (CT), and 20 patients received RT after CT (combined-modality therapy, CMT). CT consisted of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) in 41 patients and both MOPP and doxorubicin (Adriamycin, Adria Laboratories, Columbus, OH), bleomycin, vinblastine, and dacarbazine in two patients. RT was added for patients who had a partial response (PR) to CT (n = 11) and/or for initial bulky thoracic disease (n = 12).
Results:
With a median follow-up of 83 months, the 7-year actuarial freedom from progression (FFP) and survival rates for all patients were 69% and 78%, respectively. For patients achieving a complete response (CR) to CT, the 7-year FFP rate was 73% and for patients with a PR it was 90% (P value not significant). The actuarial overall survival rates at 7 years were 88% for patients with CR versus 80% for patients with PR. In contrast, patients with either no response (one patient) or progressive disease (four patients) after CT had a significantly worse prognosis than patients with CR, with a 7-year actuarial survival rate of 40% (P = 0.006). FFP after CT alone was significantly more prevalent in patients with Stage IVA (11 of 13 patients) than in patients with Stage IVB disease (2 of 10 patients; P = 0.003). For these symptomatic patients, failures were almost exclusively (seven of eight patients) in sites of initial nodal disease. The addition of adjuvant RT improved the progression-free survival for patients with B symptoms: 2 of 13 patients had relapses after CMT versus 8 of 10 patients treated with CT alone (P = 0.003).
Conclusions:
This retrospective analysis of MOPP alone compared with MOPP plus RT showed a significant difference in FFP in patients with Stage IVB HD favoring CMT.