Hodgkin's disease stage III. Staging laparotomy with partial splenectomy. Treatment results in children

Purpose We present a group of pediatric patients with Hodgkin's disease (HD ) stage III. Staging laparotomy included partial splenectomy. These patient s were treated with 2 chemotherapy regimens plus low-dose involved field (I F) radiotherapy. Patients and Methods In a 10 year period (1986-1996) patients with HD were assessed and surgically staged. Sixty-three evaluable untreated patients we re included. After a staging laparotomy the patients received two different non-random treatment regimens. Twenty-three consecutive patients (1986-198 9) had 6 courses of MOPP (mechlorethamine, vincristine, procarbazine, predn isone) and low-dose (25 Gy) IF radiotherapy. From 1989 to 1996, 40 consecut ive patients received ABVD (adriamycin, bleomycin, vinblastine, dacarbazine ) alternated with MOPP for 6 courses and low-dose (25 Gy) IF radiation. Results Patient's age ranged from 2 to 16 years, mean of 7.9 and a SD of 4. 4. Staging laparotomy with partial splenectomy was done in 56/63 (89%) of t he patients; the remaining 7 (11%) were staged with an abdominal tomography (CAT) and gallium scan. Overall survival was 92% and disease-free survival 80% (p 0.5). No differences were found with respect to survival rate among MOPP and ABVD/ MOPP (p 0.3). Conclusion Partial splenectomy appears as an accurate and safe procedure. W e believe it offers more accuracy in detecting HD than the image studies. S imilar response but less morbi-mortality was noticed with ABVD-MOPP than MO PP alone.