The Challenge of Pediatric Hodgkin's Disease-Where is the Balance Between Cure and Long-Term Toxicity?: A report of the West German multicenter studies DAL-HD-78, DAL-HD-82 and DAL-HD-85

From June 1978 until December 1989 more than 600 children under the age of 16 were treated for Hodgkin's disease in West Germany. In three consecutive multicenter studies (DAL-HD-78, HD-82, HD-85) a combined modality treatment concept was used. The aim of all these studies was to reduce the total dose and the extent of radiotherapy as well as the intensity of chemotherapy. In addition, the invasive abdominal staging procedures and the indications for splenectomy were reappraised, so that the number of laparotomies and splenectomies could be restricted to cases with an high probability of abdominal and/or splenic involvement. Special attention was directed to the effects of radio-and chemotherapy on thyroid and gonadal function as well as the development of secondary malignancies. We conclude, that patients treated for Hodgkin's disease with the combined modality treatment regimen (HD-78, HD-82), which included procarbazine, had a high probability of long term survival in first continuous complete remission (CCR). Omitting procarbazine (HD-85) significantly reduced the number of patients in first CCR in stages IIB to IV demonstrating the efficacy of this drug in the treatment of Hodgkin's disease. On the other hand, procarbazine appeared to be the major gonadotoxic drug causing predominantly testicular injury affecting mainly spermatogenesis. Few secondary malignancies have been observed, until now, however long term follow-up will be needed, to document side effects as well as the efficacy of the different therapeutic regimen.