The staging of Hodgkin's disease in children reviewed

Changing role of surgery in childhood lymphomas

The use of combinations of chemo- and radiotherapy have decreased the need for surgical staging of Hodgkin's disease. The goal of decreasing therapy while maintaining cure rates, however, recreates a need for staging. Attempts are being made to devise criteria to decrease the need for surgical staging or to decrease the extent of the procedure. Non-Hodgkin's lymphoma requires adequate tissue samples for analysis, for example, for immunophenotyping to determine treatment. Surgical resection in non-Hodgkin's lymphoma is inadequate for treatment but may be helpful. Debulking, however, is no longer recommended.

Hodgkin's disease in Kenya

A total of 136 patients with Hodgkin's disease (HD) seen at a national referral hospital in Kenya over a 15-year period were studied. The overall male-to-female ratio was 2.6:1, with 65% of patients younger than 20 years of age. The bimodal incidence of HD frequently seen in the developed nations was absent, and the histologic pattern of the disease was similar to that seen in other African countries. Fifty percent of patients had advanced-stage disease when first seen. Over two thirds of patients treated had a clinical remission, and the relapse rate in all stages was approximately 30%. Therapy-related complications were common, with frequent myelosuppression and younger patients more susceptible.

Hodgkin's disease in children: seventeen years experience at the Instituto Português de Oncologia de Francisco Gentil

The experience of 52 children with Hodgkin's disease was reviewed. Compared with Hodgkin's disease in adults there was an increased incidence among boys. Mixed cellularity (MC) was the most common histologic type (60.5% in boys, and 64.4% in girls) as was also observed in adults (61.1% in men and 63.0% in women). The methods of therapy consisted of three main groups: extended-field radiotherapy (EFRT) + MOPP; involved-field radiotherapy (IVRT) + MOPP, 44.4% for IVRT + Monochemotherapy, and 80% for EFRT alone. The progressive improvement in results was associated with the change from IVRT to EFRT and the introduction of multiagent chemotherapy.

Management of neoplasms of the head and neck in children. II. Malignant tumors

The otolaryngologist who treats children must have knowledge of the neoplasms that can occur in childhood. Such tumors are usually mesenchymal in origin and may be benign or malignant. Diagnosis and management of the more common benign tumors are undertaken by the otolaryngologist because local excision is generally curative. The proper treatment of malignant lesions requires a more extensive, multidisciplinary team, which includes a pediatric oncologist, diagnostic and therapeutic radiologist, and pathologist, in addition to the otolaryngologist. This article outlines the types of malignant neoplasms that occur in childhood and discusses current approaches to therapy.

The Value and Present Indications of Staging Laparotomy in Hodgkin's Disease

From December 1971 to December 1976 224 patients with Hodgkin's disease underwent diagnostic laparotomy and splenectomy under a multidisciplinary protocol of treatment. In 149/224 (66.5%) the clinical stage of the disease was confirmed, whereas in 75/224 (33.5%) it was modified after surgery. In 7.6% of the patients (17/224) there were postoperative complications. One patient died of myocardial infarction. The rate of complications in the last 100 cases was 5%. Preoperative patient selection, excluding those definitely in stage IV, is of relevance, and it can be done by iliac crest biopsy and laparoscopy. Although a better exploitation of some diagnostic procedures (lymphangiography, laparoscopy) and the expanding use of chemotherapy may reduce in the future the need for staging laparotomy and splenectomy, diagnostic laparotomy is still indicated for the selection and preparation of patients for radiation therapy in stages I, II and III.

Combination chemotherapy and radiotherapy for Hodgkin's disease in children

31 children with Hodgkin's disease were treated at the Children's Hospital, University of Munich, between 1963-1976. Before 1971 the diagnosis of abdominal involvement was based solely on physical findings and radiological studies. Treatment consisted of involved-field radiation; chemotherapy was added in selected cases. Of 15 children treated between 1963-1971, 5 are still in their first remission and 2 in their second remission. Since 1971 exploratory laparotomy and splenectomy have been performed. Radiation therapy was changed from involved- to extended-field therapy and combination chemotherapy was added in all the children. No patient from this group of 16 children relapsed during a median observation time of 24 months (range 12-55 months). The toxicity of the combined treatment does not seem to be prohibitive.