Results of a changing treatment philosophy for children with stage I Hodgkin's disease: A 35‐year experience

Over the last four decades, significant changes have occurred in the management of childhood stage I Hodgkin's disease. Between 1949 and 1984, 50 children, ages 4 to 16 years, were treated for stage I Hodgkin's disease at The University of Texas M. D. Anderson Cancer Center. Nineteen children had clinically staged (CS) disease. Thirty‐one patients were pathologically staged (PS). Thirty‐four children were treated with radiotherapy only, 12 were treated with both radiotherapy and chemotherapy, and 3 patients were treated with combination chemotherapy alone. All patients were followed from 32 to 311 months (median 170 months). Five‐, 10‐, and 15‐year actuarial survival rates for all patients were 94, 89, and 84%, respectively. The corresponding freedom from relapse (FFR) rates were 76, 69, and 69% respectively. The 10‐year actuarial survival and FFR rates for CS patients were 79 and 42%. The corresponding rates for PS patients were 97 and 86%. In patients with PSI disease, actuarial 10‐year FFR rates of 100% were obtained either with regional radiotherapy alone or with combination chemotherapy and involved field radiotherapy. The following delayed adverse effects of treatment were observed: growth abnormalities in 17, aspermia in 3, thyroid abnormalities in 11 (two carcinomas), and second malignancies beyond the radiotherapy fields in 2. We conclude with a recommendation of combined chemotherapy and involved field radiation for children who have not fulfilled their growth potential, to achieve high cure rates, while minimizing morbidity.