Present and future strategies of treatment in childhood Hodgkin's lymphomas

With the dramatic improvement of therapeutic results in Hodgkin's disease patients, challenges still remain in identifying the minority of patients with a poor prognosis who need intensive therapy and in reducing the costs of therapy in the successful outcome of the disease in children as in adults. It has been progressively recognized that therapeutic problems of children are similar to those of adult patients. However, the late effects of staging splenectomy and of radiotherapy on growing patients are more severe in children and the most serious sequelae is that of developing a second malignancy in patients who will have a very long life span. Ways of decreasing the long-term effects of therapy have been different in adults and children. The wide use of efficient chemotherapy has allowed omission of staging laparotomy, and reduction of the fields and doses of radiation. Compared to treatment with chemotherapy alone, which requires high cumulative doses of drugs with a potential toxicity, combined modality therapy has emerged as the best treatment for children, with low-dose and limited-volume irradiation, short chemotherapy and without the administration of alkylating agents and anthracyclines in selected groups of patients.