Hodgkin's Disease in Children

Abstract

Summary.-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.

Hodgkin's disease in children. A ten-year experience in South Africa

“…' Despite this awareness of immunologic disturbances21-22 and the critical studies bringing perspective to the relationship between splenectomy and treatment,' there remains a need for caution. 23 Chemotherapy is an attractive treatment in children because it avoids the impairment of bone growth that accompanies radiotherapy.' The current study follows the precedent set in and was designed to see whether drug therapy is effective in Stage I and Stage I1 disease, a situation that contrasts not only with the practice in adults where radiotherapy is currently the more traditional form of management, but also in many centers treating children.…”

Paediatric Hodgkin’s Disease - A study of 232 Cases Seen at Gujarat Cancer & Research Institute, Ahmedabad

“…Hisopathological classification was according to Lukes & Buttler scheme. 4 21 Fuller et al, 22 Shrith et al, 23 and Donaldson et al, 24 there is great paucity of information regarding Hodgkin's disease in under developed and developing countries.…”

The changing role of staging laparotomy in Hodgkin's disease: A personal series of 310 patients

“…Younger children receive chemotherapy if the lymphogram is positive or the histology is unfavourable, but localized disease is treated by local irradiation alone to avoid irradiation of growing bones. Thus, staging laparotomy is avoided for children under the age of 11 years (8).…”