PEDIATRIC HODGKINS-DISEASE IN COSTA-RICA - 12 YEARS EXPERIENCE OF PRIMARY-TREATMENT BY CHEMOTHERAPY ALONE, WITHOUT STAGING LAPAROTOMY

This is a prospective and nonrandomized study in which 86 children wit h previously untreated Hodgkin's disease (HD) were clinically staged ( CS) and treated with chemotherapy (CT) alone. Fifty-two (CS IA-38, IIA -7, IIB-3, IIIA-4) received six courses of cyclophosphamide, vinblasti ne, procarbazine, and prednisone (CVPP). Ten (CS IA with peripheral no des) received only three courses of CVPP with a reinforcement of C on day 8. Twenty-four (CS IIIB-18, IVA-2, IVB-4) received six courses of CVPP alternating with six courses of epirubicine, bleomycine, and vinc ristine (EBO). Surgical staging was not performed in any patient. Two patients (CS IIIB) had partial remission and died from progressive dis ease. Seventy out of 86 children have not relapsed and are in complete remission with a median follow-up of 65 months (range 13-156 months); 14 children relapsed seven to 37 months from diagnosis (median 16 mon ths); one of them (IV B) died of disease. Thirteen are in second and t hird remission (median 55 months). Actuarial five year survival rates and relapse-free survival rates are 100% and 90% for CS I to IIIA and 81% and 60% for CS IIIB and IV, respectively. As a result of this stud y, we can conclude that in developing countries most of the children w ith HD staged by noninvasive diagnostic techniques can be cured with C T alone as primary treatment and thus will not suffer from the late ef fects of radiotherapy (RT) and the morbidity of laparotomy and splenec tomy. RT alone or with other CT combinations should be considered for children who develop relapse of HD. (C) 1994 Wiley-Liss, Inc.