Hodgkin's disease in children: Treatment with MOPP and low‐dose, extended field irradiation without laparotomy late results and toxicity

Abstract

The 10 year results of a trial of bimodal treatment of Hodgkin's disease in children with 6 cycles of MOPP and low-dose extended field irradiation, without staging laparotomy, were for 57 children in all stages as follows: survival 85%, relapse-free survival 80%, and survival-free of second relapse 86%. There were three fatal toxic events, two due to viral infection and one to a second malignant tumor (NHL). Three other patients developed a second malignant tumour, and one developed a thyroid adenoma. No patient developed acute leukemia. These results are compared with the results of treatment of surgically staged children by extended field irradiation alone, with bimodal treatment reserved for relapse or advanced disease at diagnosis. Initial bimodal treatment improved the overall 10 year survival free from a second relapse rate by 20% (86% vs. 66%). No major difference in treatment toxicity between these two groups has emerged during the first 10 years of follow-up. We conclude that, except for favourable CS-1 presentations, children with Hodgkin's disease confined to the lymphatic system should be given bimodal treatment, but that the least morbid effective combination remains to be determined.

Outcome of a risk-related therapeutic strategy used prospectively in a population-based study of Hodgkin's lymphoma in adolescents

“…This may be another explanation of the differences between the present investigation and that of Yung co-workers; most of the patients in the latter study were registered at the time of recruitment to clinical trials. While several studies (Jenkin et al, 1982;Shankar et al, 1998;Schellong et al, 1999;Oguz et al, 2005;Foltz et al, 2006) stratified patients to receive therapy based on stage of disease at presentation, no group specifically took into account additional prognostic factors such as those that comprise the SNLG index. Given the population-based nature of our study and the age range of patients included, we contend that the survival data presented in this cohort, the small number of patients requiring salvage therapy, and to date lack of secondary malignancy justifies our risk-adapted approach.…”

“…More recently, in some areas, patients are being treated on designated teenage cancer units either by paediatric or adult teams. It is unsurprising, therefore, that there are considerable variations in the therapeutic regimens used in the management of these patients; while some patients are treated using regimens primarily designed for children (Jenkin et al, 1982;Ekert et al, 1988;Hudson et al, 1993;Hunger et al, 1994;Shankar et al, 1997Shankar et al, , 1998Weiner et al, 1997;Hutchinson et al, 1998;Schellong et al, 1999;Landmann-Parker et al, 2000), others are managed using adulttype approaches (Proctor et al, 1991;Yung et al, 2004).…”

Treatment of Hodgkin’s lymphoma in children

“…[4] Hodgkin lenfomada eskiden patolojik evreleme yaygın iken, zaman içinde hem Avrupa, hem de Amerika'da klinik evreleme uygulamasına geçilmiştir. [5][6][7] Detaylı anamnez (B semptomları yönünden de), fizik muayene ve gerekli görüntüleme yöntemle-ri ile klinik evreleme yapılmaktadır. Nazofarenks bölgesi dahil boyun bölgesini görüntülemede bilgisayarlı tomografi (BT) veya manyetik rezonans görüntülemesi (MRG); mediastinal bölgeyi değerlendirmede posteroanterior ve lateral akciğer grafileri ve BT genellikle yeterlidir.…”

“…[8,9,[30][31][32] Bazı merkezlerde evre IA'da radyoterapi tek tedavi şek-li olarak uygulanmakta idi. [33,34] Ancak günümüzde çocukluk çağı HL'de radyoterapi tek tedavi şekli olarak kullanılmamaktadır.…”

Family history of cancer as a risk factor for second malignancies after Hodgkin's lymphoma

“…The proportion of long-term survivors following Hodgkin's lymphoma (HL) has increased since the mid-twentieth century (Devita et al, 1970;Jenkin et al, 1990;Fuchs et al, 2006). Long-term survivors of HL have a shorter life expectancy compared with the normal population, since they have a significantly elevated risk of developing second malignancies (SMs), heart diseases, lung diseases, and infections; SM being the commonest cause of death (Mauch, 1996;Hoppe, 1997;Swerdlow et al, 2000;Dores et al, 2002;Foss Abrahamsen et al, 2002;Ng et al, 2002;Aleman et al, 2003).…”