An evaluation of long-term survival and treatment complications in children with Hodgkin's disease.

Between April 1969 and July 1977, 83 patients, 16 years or younger, with pathologically staged IA-IIIB Hodgkin's disease were seen and treated at the Joint Center for Radiation Therapy. The five-year actuarial relapse-free and overall survivals were 82 and 95%, respectively, with a median follow-up from diagnosis of 65 months. Relapse occurred in 6/50 Stage IA-IIA, 2/9 Stage IIB, 4/9 Stage IIIA, and 3/15 Stage IIIB patients. Of patients who relapsed, 11/15 are currently disease-free following retreatment with chemotherapy. Nine patients with Stage IV disease were also evaluated. Four of seven patients initially treated with chemotherapy remain free of disease. Forty-two patients in this study were treated with mantle and para-aortic irradiation alone, thus avoiding the risk of sterility associated with pelvic irradiation or MOPP chemotherapy while retaining a high probability for long-term disease-free survival. Complications of radiation therapy included growth retardation and thyroid function abnormalities in some patients. Standing height measurements were normal regardless of age at initial treatment, however, 16 of 23 patients 3-12 years old at initial treatment had sitting heights measuring more than one standard deviation below the mean. Intraclavicular distances were shortened in some patients and examples are shown. Thyroid stimulating hormone levels were elevated in 21 of 37 patients evaluated. Radiation therapy, without adjuvant chemotherapy remains an important treatment approach for children with early stage Hodgkin's disease.