Clinical Outcomes and Long-Term Effects of Consolidative Radiotherapy in Paediatric Hodgkin's Lymphoma

Objective: To evaluate the long-term effects and disease outcomes of consolidative radiotherapy in paediatric Hodgkin's lymphoma (PHL). Study Design: Descriptive study. Place and Duration of the Study: Department of Paediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from March to November, 2023. Methodology: This retrospective cohort study was conducted on 91 PHL patients. All patients with the presence of residual disease on interim PET scan received radiation therapy. A standard dose of 19.8 Gy was given as 11 fractions, and boost was given to bulky disease as 10 Gy in 5 fractions. Data regarding patient demographics, disease characteristics, and treatment details were collected from the institutional database. Results: Out of the 91 patients, 73 (80.2%) were male and 18 (19.8%) were female. The overall mean age at presentation was 7.7 +/- 3.3 years. High-risk disease was found in 81 (89%), while 44 (48.4%) had stage IV disease. Complete remission was achieved in 70 (76.9%), loss to follow-up in 11 (12.1%), disease progression/relapse in 4 (4.4%), and death during treatment in 6 (6.6%) patients. The five-year overall survival was 90%, and event-free survival was 76.9%. During treatment, a total of nine patients had moderate-to-severe left ventricular dysfunction, six patients had altered thyroid profiles (hypothyroidism), three developed pulmonary fibrosis, and one patient developed cerebellar ataxia. Conclusion: There is a good five-year overall and event-free survival. Cardio toxicity, hypothyroidism, and pulmonary fibrosis were common long-term chemotherapy / radiotherapy-related side effects. Prospective randomised controlled trial is needed to reduce dose of radiotherapy by giving it to PET-positive residual disease at the end of treatment rather than at mid-assessment.