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Hodgkin's disease in children
Insights
Inadequate staging for childhood Hodgkin's disease leads to poor outcomes with involved-field radiotherapy. Extended-field radiotherapy and chemotherapy show promising results, comparable to adult treatments.
Area of Science:
- Pediatric Oncology
- Hematology
- Radiation Oncology
Background:
- Hodgkin's disease in children presents unique challenges compared to adults, including a higher male incidence and specific histological subtypes.
- Accurate staging is crucial for effective treatment planning in pediatric Hodgkin's disease.
Purpose of the Study:
- To evaluate the efficacy of different staging and treatment modalities for childhood Hodgkin's disease.
- To compare treatment outcomes based on staging accuracy and therapeutic approach.
Main Methods:
- Retrospective analysis of 59 children with Hodgkin's disease over 34 years.
- Comparison of treatment outcomes (remission rates, survival) based on radiotherapy fields (involved vs. extended) and chemotherapy use.
- Assessment of staging procedures including lymphography and laparotomy.
Main Results:
- Involved-field radiotherapy after inadequate staging yielded a 3-year remission rate of only 13%.
- Extended-field radiotherapy with adequate staging resulted in a 72% 3-year remission rate.
- Combination chemotherapy achieved high remission rates (70%) in advanced stages and after relapse (66%).
- Staging laparotomy identified intra-abdominal disease in 50% of cases, including splenic involvement.
Conclusions:
- Involved-field radiotherapy is not recommended for inadequately staged childhood Hodgkin's disease.
- Extended-field radiotherapy and combination chemotherapy offer outcomes comparable to adult treatments.
- The benefits of staging laparotomy and treatment must be weighed against potential complications in pediatric patients.
Abstract:
Fifty-nine children with Hodgkin's disease were seen over a 34-year period. Compared with Hodgkin's disease in adults, there was an increased male incidence, especially in the younger children. This was associated with an increased male incidence of lymphocyte-predominant histology. Forty-six patients underwent lymphography as part of their staging, and 13 had staging laparotomies. The 5-year survival for the entire group was 85%, with a median survival of 10 years. Response to radiotherapy in children with Stages I-IIIA disease was: 12 children treated with involved-field radiotherapy after inadequate clinical staging had a 3-year remission rate of 13%, and a median length of remission of 18 months; 24 children treated with extended-field radiotherapy after adequate clinical staging, including lymphography, had a 3-year remission rate of 72%, and a median duration of remission not yet reached; 3 children treated with elective local radiotherapy for Stage IA disease after intensive clinical staging remain in complete remission for periods of up to 34 months. Eight out of 10 children with Stages IIIB-IV disease, treated with combination chemotherapy, achieved complete remission with a 3-year remission rate of 70%; 7 children treated with combination chemotherapy following relapse after radiotherapy all achieved complete remission with a 3-year complete remission rate of 66%. Thirteen children underwent laparotomy and splenectomy as a staging procedure. Five were found to have intra-abdominal disease, including 4 with splenic involvement. These results show that there is no place for involved-field radiotherapy after inadequate clinical staging, in the management of childhood Hodgkin's disease. Extended-field radiotherapy after adequate staging, and combination chemotherapy, produce results which are as good as those for adults, but the benefits of these treatments and of staging laparotomy must be balanced against the possible complications when they are used in children. These problems are discussed and a scheme of management is proposed.