HODGKIN DISEASE IN CHILDREN - REDUCED TAILORED CHEMOTHERAPY FOR STAGEI-II DISEASE

Purpose: Between January 1982 and January 1994, 46 children with stage I-II Hodgkin disease were treated with a tailored regimen to maintain a high cure rate while reducing toxicity. Patients and Methods: Forty -six previously untreated children with stage I-II Hodgkin disease rec eived four to six courses of cyclophosphamide, oncovin, procarbazine, and prednisone (COPP) alternating with doxorubicin, bleomycin, vinblas tine, and dacarbazine (ABVD), tailored according to clinical response. Staging was based on various imaging modalities and gallium scan, but surgical staging was not performed. Radiotherapy was given only to bu lky mediastinal disease. Results: The median age at diagnosis was 13 y ears (range 4-18) and only 4 of 46 children had B symptoms. The majori ty (31 of 46) had stage II disease; 10 had bulky mediastinal disease. Nodular sclerosis histology predominated (32 of 46). Gallium scan was positive in 66% of the patients who were evaluated. Forty-three patien ts (93%) achieved complete remission after planned therapy. Thirty-six patients (78%) received chemotherapy alone, and 10 (22%) received com bined-modality treatment. Fifteen children (33%) completed treatment w ith only four courses of COPP/ABVD. Overall freedom from relapse was 8 7% and overall survival was 98% with a median follow-up of 51/2 years. Long-term treatment-related morbidity was found mainly in patients re ceiving radiotherapy. Conclusion: Comprehensive clinical staging combi ned with tailored COPP/ABVD therapy according to response results in e xcellent disease control and may reduce toxicity.