Pediatric Hodgkin's disease.

Thirty-two patients were treated in this Department from 1981-1992. The median age was 14 years (range 4 years to 17 years). There are 6 patients (19%) below the age of 10 years, 16 patients (50%) between 11 years to 15 years, and 10 patients (31%) above 16 years. Twenty-three patients (72%) are male and 9 patients (28%) are female. Thirty-one patients (97%) are white, and 1 patient (3%) is Afro-American. The stages of the patients are: Stage I--7 patients, Stage II--12 patients, Stage III--9 patients, and Stage IV--4 patients. Twenty-one patients (66%) in the early period of the study were staged surgically by staging laparotomy. The most common sites are: neck (84%), mediastinum (66%), and para-aortic lymph nodes (22%). Twenty-five patients (78%) have nodular sclerosing type, 5 patients (16%) have mixed cellularity, and 2 patients (6%) have lymphocytic predominant type. Eight patients (25%) were treated with radiation alone and 24 patients (75%) were treated with a combination of chemotherapy and radiation. Of the radiation group, 5 patients were treated with mantle field; 2 patients with mantle, para-aortic node and splenic pedicles; and 1 patient with mini-mantle field. The treatment was given with 4 or 6 mv photon, and the median dose was 36 Gray (range 32-40 Gy). Of the combination group, 11 patients were treated with ABVD (doxorubicin + bleomycin + vinbastine + dacarbazine), 10 patients with ABVD/MOPP (MOPP: mechlorethamine + vincristine + procarbazine + prednisone) and 3 patients with MOPP alone. The median irradiation dose in the combination group was 25 Gy (range 21 Gy-36 Gy). All the patients in this group were treated to the involved site with custom blocks. Three patients were lost for follow-up because of transfers out-of-state and could not be located. All patients in Stages I and II are alive without any evidence of disease at the last follow-up. One patient with Stage III disease developed a second cancer (PNET: primitive neuroectodermal tumor) 111 months after combination treatment and has died. One Stage IV patient has died with Hodgkin's disease 28 months after treatment with combination therapy. All other patients are followed closely along with the primary physicians and consultants.