REDUCTION OF RADIATION DOSAGE TO 20-30 GY IN THE FRAMEWORK OF A COMBINED CHEMORADIOTHERAPY IN CHILDHOOD HODGKINS-DISEASE - A REPORT OF THE COOPERATIVE THERAPY STUDY DAL-HD-87

The main objective of the multicenter study DAL-HD-87 was to evaluate for the involved-field irradiation a dose reduction by 5 Gy compared w ith the precursor studies HD-82 and HD-85. Moreover. the decisional st rategy for selective laparotomy developed on the basis of retrospectiv e analyses in study HD-82 was to be tested in a prospective design. Ch emotherapy in group 1 (stages I, IIA) consisted in 2 OPA cycles (vincr istine, prednisone, adriamycine). Group 2 (stages II(E)A, IIB, IIIA) r eceived 2 x OPA + 2 x COP(P), and group 3 (stages II(E)B, IIIB, IV) 2 x OPPA (with procarbacine) + 4 x COP(P). For the subsequent radiothera py, doses of 30, 25, and 20 Gy respectively were applied in the 3 grou ps. Fields with incomplete lymphoma regression were to receive an addi tional boost of 5-10 Gy. - Exploratory laparotomy was considered indic ated in the event of abnormal findings in abdominal CT/ultrasonography and/or enlargement of lymph nodes at the pulmonary hilus. Results: Fr om Dec. 1986 to Sept. 1990, 204 pts from 51 centres were enrolled in t he study. 196 were evaluable. 109 pts (55.6%) were laparotomized, 58 ( 29.6%) splenectomized. The accuracy for the prediction of an abdominal involvement was 72.3% in case of abnormal findings in abdominal CT/ul trasound but only 36.4% in case of enlarged lymph nodes at the pulmona ry hilus without abdominal abnormalities. 91.2% of the removed spleens were proven involved. - 2 out of 196 pts suffered progression under t reatment, and 22 relapsed (as of 1 Jan, 1994). 6 pts died, 4 of whom s uccumbed to Hodgkin's disease, and 2 to intercurrent infections. 2 pts in first remission developed a secondary malignancy, namely 1 maligna nt histiocytoma in radiation field and 1 ANLL. Another patient develop ed a thyroid carcinoma following salvage therapy for a relapse. The pr obabilities of event-free survival (EFS) and survival after 7 years ar e for the total group: 85% and 97%, in group 1: 84% and 99%, in group 2: 82% and 93%, and group 3: 89% and 95%. Comparison with the precurso r studies HD-82 and HD-85 reveals that the dose reduction in radiother apy has not affected the results. Differences in EFS are exclusively c orrelated with changes in chemotherapy.