Children up to 18 years with Hodgkin's lymphoma are treated as in the German protocol GPOH-HD-95. This is the protocol resulting from an international collaborative study where Norway was also a participant. This protocol, including its most recent changes, is currently the standard treatment for childhood Hodgkin's lymphoma in Norway. The treatment takes place at regional hospitals only, or under their supervision.
The treatment consists of chemotherapy for all patients, and radiation therapy for most after finishing chemotherapy. It is therefore very important to have a close cooperation between the pediatric oncologist and oncologist/radiation therapist from the start of treatment. The patients are stratified into therapy groups according to stage. Therapy group 1 includes the early stages. Therapy group 2 includes the intermediary stages and therapy group 3 includes the advanced stages.
|Therapy groups according to GPOH-HD-95
||I A/B and II A
||IEA/B, IIEA, II B or III A
||IIEB, IIIEA/B, III B or IV A/B
Treatment consists of 2-6 regimens with acronyms OPPA, OEPA and COPP. All of the regimens last for 15 days and are repeated every 4 weeks. In the GPOH-HD-95 protocol, girls receive OPPA for the first two courses regardless of therapy group. Recently, OEPA has also been given to girls for fertility reasons. Boys also receive OEPA since it is shown to cause lower rates of infertility in men. The patients in therapy group 1 only receive 2 courses. In therapy groups 2 and 3, COPP is also given 2 and 4 times, respectively.
Patients in therapy group 1 in complete radiological remission after 2 OPPA/OEPA courses do not have radiation therapy. Radiation therapy is given if there is remaining tumor. Patients in therapy groups 2 and 3 will have radiation therapy regardless after completing 4 and 6 courses. Radiation therapy is given mainly to the tumor area (involved field). The amount of irradiation is normally 20 Gy (1.8 Gy x 11), but for areas with less than 75% reduction of original tumor volume, it is recommended to give 30 Gy. For areas with less than 75% reduction and remaining tumor over 100 ml in volume, it is recommended to give 35 Gy. There are more detailed specifications in the protocol for radiation therapy, for example, with primary infiltration in the mediastinum, lungs, bone marrow, or skeleton, which must be assessed carefully.
Since 2008, the EuroNet-PHL-C1 protocol is the recommended treatment in Norway. Participation in this study is also recommended.