Response-adapted omission of radiotherapy in children and adolescents with early-stage classical Hodgkin lymphoma and an adequate response to vincristine, etoposide, prednisone, and doxorubicin (EuroNet-PHL-C1): a titration study

Deep‐learning based classification of a tumor marker for prognosis on Hodgkin's disease

“…All of the 83 cases used for the investigations were selected from the EuroNet‐PHL‐C2 study, an international cross‐group study of classical Hodgkin's lymphoma in children and adolescents. The treatment regimen based on a risk‐ and response‐adapted treatment approach 22,23 . Patients were all administered two cycles of induction chemotherapy by vincristine, etoposide, prednisolone, and doxorubicin (OEPA), followed by early response assessment (ERA), including whole‐body CT or MRI and FDG‐PET scan 24 .…”

“…The treatment regimen based on a risk-and response-adapted treatment approach. 22,23 Patients were all administered two cycles of induction chemotherapy by vincristine, etoposide, prednisolone, and doxorubicin (OEPA), followed by early response assessment (ERA), including whole-body CT or MRI and FDG-PET scan. 24 Patients who achieved complete metabolic remission received one to four cycles of further chemotherapy according to diagnostic stage and stratification of the treatment risk group.…”

Classic Hodgkin Lymphoma in Adolescents and Young Adults

“…In Europe, among patients age younger than 18 years, the EuroNet-PHL-C1 trial investigated two cycles of vincristine, etoposide, prednisone, and doxorubicin (OEPA) with involved-field radiotherapy (IFRT) administered at a total dose of 19.8 Gy reserved only for those with an inadequate response. 19 Adequate response, defined as ≥50% reduction in tumor volume and positron emission tomography (PET) activity ≤mediastinal blood pool or background activity, was achieved in 62%. Although the target 90% 5-year event-free survival (EFS) rate was not achieved for those patients who did not receive radiotherapy (RT), post hoc analyses showed that the target EFS was attained in those without risk factors of an elevated ESR or bulky involvement.…”

Re-Examining Trials of Radiotherapy Omission: When Less Is Not Always More

“…By contrast, EuroNet-PHL-C1 was a prospective, nonrandomized trial of positron emission tomography–directed RT omission in early-stage pediatric classical Hodgkin lymphoma wherein patients achieving at least partial response after two cycles of chemotherapy did not receive RT. 6 Although nonrandomized, the statistical design was similar to that of a noninferiority trial with a target event-free survival (EFS) of 90% at 5 years in the omission group. This benchmark was not met (the 5-year EFS was 86.5% [95% CI, 83.3% to 89.8%]).…”

“…Over the past decade, there has been growing interest in ways to deintensify oncologic therapies across modalities including RT. In the past year, three RT omission trials were published—Preoperative Radiation Or Selective Preoperative Radiation and Evaluation before Chemotherapy and Total Mesorectal Excision (PROSPECT) for low-risk locally advanced rectal cancer, 4 Prime II for localized breast cancer, 5 and EuroNet-PHL-C1 for pediatric Hodgkin lymphoma 6 —concluding that RT can be omitted. While safe treatment de-escalation represents an advancement for patients, and the three trials were rigorously developed and analyzed, there are methodological issues related to study design and interpretation in each trial that clinicians should consider, emphasizing the nuances in decision making regarding RT omission.…”