Association of Combined Modality Therapy vs Chemotherapy Alone With Overall Survival in Early-Stage Pediatric Hodgkin Lymphoma

Abstract

IMPORTANCE To date, there is no well-defined standard of care for early-stage pediatric Hodgkin lymphoma (HL), which may include chemotherapy alone or combined modality therapy (CMT) with chemotherapy followed by radiotherapy. Although the use of radiotherapy in pediatric HL is decreasing, this strategy remains controversial. OBJECTIVE To examine the use of CMT in pediatric HL and its association with improved overall survival using data from a large cancer registry. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study used data from the National Cancer Database to evaluate clinical features and survival outcomes among 5657 pediatric patients (age, 0.1-21 years) who

Radiation Therapy Across Pediatric Hodgkin Lymphoma Research Group Protocols: A Report From the Staging, Evaluation, and Response Criteria Harmonization (SEARCH) for Childhood, Adolescent, and Young Adult Hodgkin Lymphoma (CAYAHL) Group

“…Ten-year overall survival now exceeds 85% with CMT for pediatric HL patients. While efforts continue to improve cure rates in the highest risk patients, the goal of contemporary HL therapy is now largely focused on reducing the late adverse effects of treatment using risk and response adapted therapies without compromising outcomes [2,3]. Substantial heterogeneity exists between national and international clinical trial protocols for pediatric and adult HL regarding optimal RT utilization.…”

“…Efforts continue to improve cure rates in the highest-risk patients, but the goal of contemporary HL therapy is now largely focused on reducing the late adverse effects of treatment using risk- and response-adapted therapies without compromising outcomes. 2 , 3 …”

Causes of death and effect of non-cancer-specific death on rates of overall survival in adult classic Hodgkin lymphoma: a populated-based competing risk analysis

“…In cancer research, overall survival based on the absolute risk of death is considered the most important endpoint to demonstrate whether new treatments can be directly beneficial. The Kaplan-Meier and Cox proportional hazard regression models are the classic techniques in survival analysis, clarifying the association between risk factors and clinical outcomes and predicting the risk of an individual's clinical outcome through hazard ratios [7,8], but in none of them are competing causes of death considered. For example, old age, advanced stage, and the lymphocyte-depletion subtype are associated with a relatively poor prognosis, and affected patients with cHL are more prone to CSD [9].…”

Irradiating Residual Disease to 30 Gy with Proton Therapy in Pediatric Mediastinal Hodgkin Lymphoma

“…Consolidative radiotherapy has been shown to improve overall survival over chemotherapy alone for patients with pediatric Hodgkin lymphoma [18]. Although higher doses of RT have been avoided in PHL to limit late effects, the greatest concern is OAR dose.…”

“…Unfortunately, such a study is not feasible in this rare disease for which the focus is on exploring targeted therapies and immunotherapies. For RT to remain relevant in future PHL studies, a smaller RT volume must be adopted and evaluated just as ISRT/involved-node radiotherapy was adopted 10 years ago alongside new RT technologies, such as intensity-modulated radiation therapy, proton therapy, and the breath-hold technique [15][16][17][18]. Understanding relapse patterns within these new field designs will help us understand whether target volumes have become too small and whether the doses we use are appropriate.…”