This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Krasin, M. J. Articles by Hudson, M. M. Search for Related Content PubMed PubMed Citation Articles by Krasin, M. J. Articles by Hudson, M. M.

Patterns of Treatment Failure in Pediatric and Young Adult Patients With Hodgkin's Disease: Local Disease Control With Combined-Modality Therapy

From the Departments of Radiological Sciences, Biostatistics, and Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN

Address reprint requests to Matthew J. Krasin, MD, Division of Radiation Oncology, St Jude Children's Research Hospital, 332 N. Lauderdale St. Memphis, TN 38105; e-mail: Matthew.Krasin{at}stjude.org

PURPOSE: Refinement in managing pediatric Hodgkin's disease (HD) requires understanding of factors associated with local treatment failure. This study defines the cumulative incidence (CI) of local failure (LF) and prognostic factors for pediatric patients treated for HD with combined-modality therapy (CMT).

PATIENTS AND METHODS: We enrolled 195 patients onto two prospective studies at St Jude Children's Research Hospital between 1990 and 2000. Patients received CMT with chemotherapy (vinblastine, doxorubicin, methotrexate, and prednisone [VAMP]; vinblastine, etoposide, prednisone, and doxorubicin; or VAMP/cyclophosphamide, vincristine, and procarbazine) and involved-field radiation therapy delivered to initial site(s) of disease on the basis of early response. Sites of disease involvement, treatment, and sites of failure were confirmed from the patients' medical record, imaging, and radiotherapy treatment records. We estimated the overall survival, event-free survival, and CI of LF.

RESULTS: With a median follow-up of 7.6 years, the CI of LF was 10.9% and 11.6% at 5 and 10 years, respectively. Twenty-seven (14%) of 195 patients experienced recurrence of HD, and 22 (81%) of those experienced LF. Bulky mediastinal disease greater than one third transthoracic diameter predicted a higher incidence of LF, but did not predict failure in the mediastinum. Male sex, low initial hemoglobin, and bulky mediastinal disease were prognostic indicators of LF. Attenuation of radiation dose to 15 Gy based on response provides excellent infield control.

CONCLUSION: CMT provides excellent local disease control in children and young adults with HD. LF remains a primary site of disease recurrence, with male sex, low initial hemoglobin, and bulky mediastinal disease predicting for LF.

Supported in part by the American-Lebanese-Syrian Associated Charities.

Presented at the 46th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, October 2-7 2004, Atlanta, GA.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

This article has been cited by other articles:

				M. L. Metzger, S. M. Castellino, M. M. Hudson, S. N. Rai, S. C. Kaste, M. J. Krasin, L. E. Kun, C.-H. Pui, and S. C. Howard Effect of Race on the Outcome of Pediatric Patients With Hodgkin's Lymphoma J. Clin. Oncol., March 10, 2008; 26(8): 1282 - 1288. [Abstract] [Full Text] [PDF]