From April 1972 to May 1980, 72 children and adolescents (aged 5 to 19 years old, median 16) with
Hodgkin's disease, clinical stages IA-IIB (IA, 18; II2A, two areas involved on the same side of the diaphragm, 23; II3+A, three areas or more, 16; IIB, 15) were prospectively treated in two successive clinical trials (H 72 and
H 77). Clinical stages IA and II2A received three courses of
mechlorethamine,
Oncovin,
procarbazine, and
prednisone (MOPP) and supradiaphragmatic
radiotherapy (40 Gy), and no
laparotomy was performed. Clinical stages II3+A and IIB received either six cycles of MOPP (H 72), three cycles of MOPP, or three cycles of
CCNU,
vinblastine,
procarbazine, and
prednisone (CVPP) (
H 77) and subsequently had a
laparotomy followed by supradiaphragmatic
radiotherapy and a lumboaortic field if results of
laparotomy were positive. Patients without evidence of mediastinal involvement did not have mediastinal
radiotherapy. At the completion of
therapy, the disease in 70 of 72 patients was
in complete remission (one failure, one death during treatment). Eight patients relapsed (in situ, 1; marginal, 1; nonirradiated subdiaphragmatic area, 6) after three to 57 months of complete remission (median 20 months); one patient died after relapse. There were three deaths after complete remission of the disease (
infection, two;
acute nonlymphocytic leukemia [
ANLL], one). As of June 1984 the median follow-up was 82 months (range, 49 to 145 months), the actuarial probabilities for survival and freedom from relapse for all patients being 91.6% and 87.6%, respectively. There was no statistical difference according to clinical stage, age (greater than 15 or less than 15 years), sex, or number of cycles of
chemotherapy (six or three). Bone growth defects related to
radiotherapy were reduced particularly in the 29 patients who did not receive mediastinal
radiotherapy. None of these patients had a mediastinal relapse.
Azoospermia was the rule for the male patients studied, but young girls and young women retained reproductive integrity.