Pediatric Hodgkin Lymphoma: on the road to a ‘radiotherapy-free’ cure rate?—Commentary on a report on final results of the Multinational Trial GPOH-HD95
During the last four decades, the treatment of children and adolescents affected by classic Hodgkin Lymphoma (HL) has achieved continuous and dramatic improvements in response and survival rates, from uniform fatality up to curability for 90% of patients (1). This success has occurred mainly in economically advantaged countries due to constant participation of children in clinical trials, the administration of pediatric cancer care in specialized centers and the continuous efforts in refining treatment intensities against the gradually discovered profiles of subacute and delayed complications of radiotherapy (RT) and multiagent chemotherapy (2,3). As a matter of fact, due to active growth and development at the time of treatment, youngsters and children may suffer of impaired growth of soft tissue and bones, and have a greater sensitivity as compared to adults, in developing thyroid and gonadal dysfunction, cardiopulmonary toxicity, and secondary neoplasms (4). In a large series including 1,876 pediatric HL survivors, the estimated cumulative incidence rates of total (grade 1 to 5) and severe grade (grade 3 to 5) chronic medical conditions were 75% and 40%, respectively, at 25 years follow-up (5).