Background and Objectives: Risk-adapted therapy for children with HL is
directed toward high survival, minimal toxicity and optimal quality of life,
with long term follow up. We assess the impact of prognostic factors associated
with local treatment failure of pediatric HL patients with unfavorable
criteria treated with combined modality: Alternating ABVD (Doxorubicin,
Bleomycin, Vinblastine and Decarbazine) and COEP (Cyclophosphamide,
Oncovin, Etoposide and Prednisone) chemotherapy and response-based, involved-
field radiation for newly diagnosed unfavorable pediatric HL patients,
also will detect toxicities and long-term complications observed in the patients.
Methods: This prospective study was carried out from January 2010 to
January 2018, with a median follow up of 74 months (range 8 - 103 months).
54 patients were eligible for this study stratified into two groups: intermediate
risk (IR) and high-risk group (HR). Patients were treated with (4 - 6 cycles)
and (6 - 8 cycles) respectively of alternating ABVD/COEP chemotherapy followed
by involved-field radiation therapy (IFRT): 15 Gy for patients achieved
complete response, and 25.5 Gy for those achieved a partial response. Results:
27 patients were IR and 27 patients were HR. There were 16 treatment failures;
5 patients had progressive disease; and 11 patients had a relapse. 9 patients
died from their disease progression. The 5-year overall survival (OS)
and event-free survival (EFS) rates (±SE) were 81.8% ± 5.7% and 71.8% ±
6.2% respectively. Multivariate analysis revealed that the only independent
factor for inferior OS was radiotherapy. Conclusion: Treatment results of
unfavourable HL patients in our study are satisfactory for with IR group but
not for HR group who needs intensification of therapy. Radiotherapy is considered
as a cornerstone in the treatment of the patients with unfavourable criteria with better assessment of early responders needed by PET-CT to identify
patients at risk for relapse.