Paediatric Hodgkin lymphoma: to irradiate or not?

In a recent study, the outcomes of over 2,000 children and adolescents diagnosed with new Hodgkin's lymphoma were analysed.

Outcomes with and without radiotherapy in paediatric Hodgkin's lymphoma

Over 2,000 children and adolescents with newly diagnosed Hodgkin's lymphoma were included in the study.
All received two cycles of vincristine/etoposide/prednisone/doxorubicin (OEPA) therapy.
Subsequent radiotherapy was only given in the absence of a response.
The results suggest that radiotherapy can be dispensed with if there is a good chemo-response and no risk factors are present.

Early stages of paediatric Hodgkin's lymphoma usually have good outcomes

The event-free five-year survival rate for paediatric Hodgkin's lymphoma stands around 90%. This is certainly also due to the intensive therapy that young patients undergo. In the vast majority of cases, OEPA chemotherapy is followed by radiotherapy. However, it is precisely this radiotherapy that affects the quality of life of those affected and is often associated with complications.

Is radiotherapy necessary?

The question of whether radiotherapy is necessary in the early stages of the disease is therefore being asked more frequently. The study authors have investigated this particular issue. More than 2,000 children and adolescents with newly diagnosed early-stage Hodgkin's lymphoma were recruited. All received two cycles of OEPA. If there was no sufficient response to the therapy (defined as a partial morphological remission or a negative PET), the chemotherapy was followed by radiotherapy. In the case of a good result after chemotherapy, radiotherapy was omitted.

Does the survival rate change?

After the completed follow-up, the event-free five-year survival rate in the group without radiotherapy was 86.5 %, while it was 88.6 % in the group with radiotherapy.

Key take-away for medical practice

Avoiding radiotherapy can be a viable option for paediatric patients with early stages of classical Hodgkin's lymphoma, but only if the patients respond well to chemotherapy and there are no risk factors. Children and adolescents with risk factors and a lack of response will most likely need the more intensive therapy.

Reference

Mauz-Körholz C, Landman-Parker J, Fernández-Teijeiro A, Attarbaschi A, Balwierz W, Bartelt JM, Beishuizen A, Boudjemaa S, Cepelova M, Ceppi F, Claviez A, Daw S, Dieckmann K, Fosså A, Gattenlöhner S, Georgi T, Hjalgrim LL, Hraskova A, Karlén J, Kurch L, Leblanc T, Mann G, Montravers F, Pears J, Pelz T, RajiÄ V, Ramsay AD, Stoevesandt D, Uyttebroeck A, Vordermark D, Körholz D, Hasenclever D, Wallace WH, Kluge R. Response-adapted omission of radiotherapy in children and adolescents with early-stage classical Hodgkin lymphoma and an adequate response to vincristine, etoposide, prednisone, and doxorubicin (EuroNet-PHL-C1): a titration study. Lancet Oncol. 2023 Mar;24(3):252-261. doi: 10.1016/S1470-2045(23)00019-0. PMID: 36858722.