Introduction
Most children with Hodgkin lymphoma (HL) can be cured with modern day chemotherapy with or without radiation therapy (RT). As the cure rates have ameliorated, the delayed effects of therapy have become an important concern. RT is one of the important causes of serious delayed effects in these young patients. Every attempt should be made to limit usage of RT to preclude secondary malignancy, endocrine impairment and cardiovascular damage. Risk and response based adaptation of protocols have led to better decision-making, reduced treatment burden and improved outcomes. Fluorodeoxyglucose based positron emission tomography-computed tomography (PET-CT) for initial disease assessment and response evaluation has now become the standard of care for HL. However, its use for treatment attenuation is debatable1,2. Moreover, dearth of availability of PET-CT facility and higher expenses still pose an obstacle in usage of this modality in low-to-middle- income countries (LMIC).
Indian pediatric oncology group (InPOG), a research/clinical trial division of Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics established disease specific research groups in 20153. With the specific mandate of promoting collaborative clinical research, InPOG-HL-15-01 was the first multicenter study that recruited patients from 27 hospitals across India for a uniform risk adapted and response based management of childhood HL4. The study utilised ABVD regimen (doxorubicin, bleomycin, vinblastine, dacarbazine) and stratified patients into early and advanced stage disease. RT was delivered to children with suboptimal response at early response assessment (ERA) or those with bulky disease. Initial disease assessment and response evaluation were done by CECT or PET-CT as per centre practice and availability of resources. We tried to evaluate the impact imaging modality used on staging, response assessment, therapy decisions especially usage of RT and outcomes of children with HL.