Response-adapted omission of radiotherapy for intermediate- and advanced-stage cHL in children and adolescents

Children and adolescents with intermediate-stage and advanced-stage classical Hodgkin lymphoma (cHL) achieve an event-free survival at 5 years of about 90% after treatment with vincristine, etoposide, prednisone, and doxorubine (OEPA) followed by cyclophosphamide, vincristine, prednisone, and procarbazine (COPP) and radiotherapy, but long-term treatment effects affect survival and quality of life. The EuroNet-PHL-C1 randomised controlled trial, at 186 hospitals across 16 European countries, showed that radiotherapy could be safely omitted in patients with intermediate- or advanced-stage cHL who adequately responded to treatment, with consolidated with COPP or COPDAC (COPP with dacarbazine replacing procarbazine). COPDAC was less effective but substantially less gonadotoxic than COPP. The authors conclude that a high proportion of patients could be spared radiotherapy, eventually reducing late effects of treatment.