What is the best treatment for children with limited-stage Hodgkin lymphoma?

Abstract

Limited-stage Hodgkin lymphoma remains a challenging problem for pediatric oncologists. Published and investigative treatment regimens represent varied approaches to balance the excellent overall and event-free survival with the substantial potential for long-term sequelae of effective treatment modalities. Regimens incorporating low-dose radiation to smaller fields and chemotherapy that limits cumulative exposure to the agents most closely associated with long-term complications have been shown to be effective for most patients. Investigative approaches to optimize overall therapy focus on identifying which patients require more or less therapy. A recent example is the use of response-based therapy as a means of limiting or omitting radiation for those with an early, rapid response to chemotherapy. Biologic markers that influence risk for treatment failure or treatment-related toxicities have been only minimally defined. This paper reviews recently published treatment regimens for children and adolescents and presents some considerations for choosing a treatment approach for individual patients.

Lymphomas

“…For patients with low-risk disease, outcomes are excellent with event-free survival (EFS) and overall survival (OS) approaching 90 and 95 %, respectively. For these patients, clinical trials are focused on an optimal balance between cure rate and late effects of treatment, with attempts to decrease or eliminate the use of radiation therapy and chemotherapy agents with signifi cant risks of infertility and second malignancy (Keller et al 2009 ).…”

Lung changes in the late periods after using various chemoradiotherapy programs for Hodgkin’s lymphoma in children and adolescents

“…По мере повышения общей и безрецидивной выживаемости в данном контингенте больных все больше внимания уделяется снижению частоты и выраженности отдаленных последствий химиотерапии и лучевой терапии. Достижение этой цели видится в уменьшении объемов и суммарной дозы облучения при условии проведения достаточно интенсивной химиотерапии, что реализовано практически во всех современных протоколах лечения данной патологии у детей [1,2,[4][5][6][7][8][9][10].…”

Current approaches in the management of low risk Hodgkin lymphoma in children and adolescents

“…Approximately 26–34% of children and adolescents with Hodgkin lymphoma (HL) present with low risk disease (Keller et al , ). Although the survival rate for low risk HL is among the highest seen in paediatric cancers, there is longstanding recognition of the long‐term toxicity that can occur as a result of therapy.…”