How do you determine whether to treat a young adult with stage IA Hodgkin Lymphoma with the adult or pediatric treatment paradigm?

There is a long history of pediatric protocols for HL differing somewhat from the adult ones, but not much biologic rationale to support this, as the disease in young adults is biologically the same as in pediatric patients. Side effects of RX may of course differ, particularly with regards to RT and growth issues. In general, the pediatric drug protocols have not been superior to the adult ones, such as ABVD, and in some cases are inferior. Thus, I would use the adult ones for almost all patients, and if the patient described meets the German criteria for favorable HL, and growth is not an issue, 2 cycles ABVD and 20gy RT seems appropriate. The evidence is a little mixed, but generally, for early stage HL not in the favorable category, I d...

Assuming it was classical HL, I would consider the extent of disease and the potential long term side effects of using ISRT. If the patient was post-pubescent (i.e. fully grown) and the RT dose to the heart and breast tissue (in a female) were to be low, I would strongly consider ABVDx2+20 Gy per GHSG HD16 study (assuming the patient met the eligibility criteria).

If the patient was pre-pubescent and bone growth was a late toxicity concern or if the heart dose and/or breast dose (in a female) would be high, then perhaps ABVDx3-4 alone if they have a CR after 2 cycles.

The AVPC regimen wasn't very successful. Patients who didn't have a CR by PET (Deauville 1 or 2) after the first cycle were subsequently asked to come back to get IFRT, due to t...