Bechara Elie, Eid Toufic, El-Dhuwaib Arwa, Tamim Hani, Noun Dolly, Borghol Raphah, Chakhachiro Zaher, Abboud Miguel R, Muwakkit Samar
Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Cancer Med. 2025 Aug;14(15):e71095. doi: 10.1002/cam4.71095.
The Euronet-PHL-C1 protocol has yielded excellent results for pediatric Hodgkin Lymphoma (HL), by omitting radiotherapy (RT) in early responders, thereby decreasing long-term toxicities. However, its application in resource-limited countries remains challenging. This study aims to evaluate patient outcomes using this protocol and the feasibility of omitting RT for early responders.
We conducted a retrospective analysis of 87 previously untreated pediatric HL patients at our Center from 2012 to 2022, following the Euronet-PHL-C1 protocol. RT was omitted for patients with an early rapid response at interim evaluation. Collected data were analyzed to determine survival outcomes and predictors of relapse.
The mean age of the patients was 13 years, with 51.7% female. B-symptoms were present in 59.8% of the patients, while 37.9% had bulky disease, 57.1% had elevated erythrocyte sedimentation rate, and 42.5% had stage IV disease. RT was omitted for early rapid responders in 22.9% of the patients. The therapy was generally well tolerated, with only 36 episodes of febrile neutropenia and no treatment-related mortality. The 5-year progression-free survival and overall survival of the entire cohort were 89.3% and 97.6%, respectively. Nine patients relapsed, and two patients died. No independent predictors of event-free survival were identified.
The implementation of Euronet-HL protocol in our center provided excellent outcomes and a safety profile despite a few challenges. While RT can be removed in low-stage, rapid-responder patients, caution persists in resource-limited settings for those with advanced stage or bulky disease, highlighting the need for prospective trials to guide safe RT omission.
Euronet-PHL-C1方案在儿童霍奇金淋巴瘤（HL）治疗中取得了优异成果，该方案通过对早期缓解者省略放疗（RT），从而降低了长期毒性。然而，其在资源有限国家的应用仍具有挑战性。本研究旨在评估使用该方案的患者结局以及对早期缓解者省略RT的可行性。
我们对2012年至2022年在本中心接受治疗的87例未经治疗的儿童HL患者进行了回顾性分析，遵循Euronet-PHL-C1方案。对中期评估时早期快速缓解的患者省略RT。分析收集的数据以确定生存结局和复发预测因素。
患者的平均年龄为13岁，女性占51.7%。59.8%的患者有B症状，37.9%有大包块病变，57.1%红细胞沉降率升高，42.5%为IV期疾病。22.9%的患者对早期快速缓解者省略了RT。该治疗总体耐受性良好，仅有36例发热性中性粒细胞减少症发作，无治疗相关死亡。整个队列的5年无进展生存率和总生存率分别为89.3%和97.6%。9例患者复发，2例患者死亡。未发现无事件生存的独立预测因素。
尽管存在一些挑战，但Euronet-HL方案在我们中心的实施提供了优异的结局和安全性。虽然对于低分期、快速缓解的患者可以省略RT，但在资源有限的环境中，对于晚期或有大包块病变的患者仍需谨慎，这突出了进行前瞻性试验以指导安全省略RT的必要性。
