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.