The Concept of the GPOH-HD 2003 Therapy Study for Pediatric Hodgkin's Disease: Evolution in the Tradition of the DAL/GPOH Studies

Abstract

Today it is possible to cure more than 90 % of children and adolescents with Hodgkin's disease with a combination of radiotherapy and chemotherapy. Since the DAL-HD 82 study, the main scientific focus has been on avoiding late effects such as the OPSI syndrome, late complications involving the heart, lungs, thyroid and/or gonads particularly sterility in men and premature onset of menopause in women, and the prevention of secondary malignancies. The GPOH-HD 2003 study will introduce FDG-PET to the initial diagnostic program and the assessment of response to therapy in order to evaluate further possibilities for reducing therapy. In this context, the central review of all clinical and radiological findings, systematically done since the DAL-HD 90 study, will be increasingly relevant in maintaining standardised stage classification and therapy group assignment which was established by the preceding studies. Continuing in the direction of the earlier studies, the indications for radiotherapy will be restricted even further. In the early stages (treatment group 1) patients with CR or a negative FDG-PET at the end of chemotherapy will receive no radiotherapy in order to reduce the risk of a secondary malignancy. In a randomized comparison, procarbazine will be replaced by dacarbazine in the COPP cycles to determine whether sterility in men and premature onset of menopause in women can be avoided by elimination of procarbazine while retaining the same clinical efficacy. Finally, relapse therapy is to be tailored according to the time of relapse, the initial therapy group, and the patient's response to the relapse therapy with more patients receiving autologous transplantation in order to further improve the results of relapse treatment.

Zusammenfassung

Durch die kombinierte Radio-Chemotherapie können über 90 % aller Kinder und Jugendlichen mit einem Morbus Hodgkin geheilt werden. Seit der DAL-HD-82-Studie steht die Vermeidung von Langzeittherapiefolgen - u. a. OPSI-Syndrom, Spätschäden am Herzen, der Lunge, der Schilddrüse und den Gonaden, und hier insbesondere die Unfruchtbarkeit beim Mann/vorzeitige Menopause bei der Frau sowie die Vermeidung von Sekundärmalignomen - im Blickpunkt des wissenschaftlichen Interesses. In der GPOH-HD-2003-Studie wird die FDG-PET in das initiale Diagnostikprogramm und in die Beurteilung des Therapieansprechens eingeführt, um weitere Möglichkeiten zur Therapiereduktionen zu evaluieren. In diesem Zusammenhang wird die seit der DAL-HD-90-Studie systematisch eingeführte Referenzbegutachtung aller klinischen und radiologischen Untersuchungsbefunde weiter an Bedeutung gewinnen, um die in den bisherigen Studien erreichte Vereinheitlichung der Stadieneinteilung und der Therapiegruppenzuordnung zu erhalten. Der Tradition der Studiengruppe folgend soll die Indikation zur Radiotherapie weiter eingeschränkt werden. In der Therapiegruppe 1, d. h. den frühen Stadien, erhalten die Patienten mit CR oder einer negativen FDG-PET am Ende der Chemotherapie keine Radiotherapie. Hierdurch soll das Risiko für die Entstehung von Sekundärmalignomen gesenkt werden. In den COPP-Zyklen wird Procarbazin im randomisierten Vergleich durch Dacarbazin ersetzt. Hierdurch soll geprüft werden, ob bei gleicher onkologischer Wirksamkeit die Unfruchtbarkeit beim Mann bzw. die vorzeitige Menopause bei der Frau durch den Verzicht auf Procarbazin vermieden werden kann. Auf der Basis der bisherigen Rezidivbehandlungen soll schließlich die Rezidivtherapie nach Zeitpunkt des Rezidives, initialer Therapiegruppe und Ansprechen auf die Rezidivtherapie gesteuert werden.

Hodgkin's disease - children - GPOH - FDG-PET radiotherapy - dacarbazine

Morbus Hodgkin - Kinder - GPOH - FDG-PET - Dakarbazin

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