The article “Radiotherapy may be omitted in children and adolescents with classical Hodgkin lymphoma in complete remission after frontline risk and response-adapted chemotherapy: A multicentre clinical trial (LH-GALOP 2017)” was published in a recent edition of Leukemia and Lymphoma Journal.
This article presents the results of a paediatric treatment for Hodgkin lymphoma, a type of Lymphoma that can affect children and adults. It is a disease with very high cure rates, with a 5-year survival rate exceeding 95% in children and adolescents. For this reason, therapy must avoid long-term toxicity to ensure optimal quality of life without health problems attributable to the treatment used.
Historically, the treatment strategy for both children and adults was based on chemotherapy and radiotherapy. Chemotherapy has been refined to minimize the risks of secondary leukemias or male infertility. However, radiotherapy is responsible for second malignancies and long-term cardiovascular damage in individuals treated with this modality during childhood and adolescence.
This treatment protocol focused on minimizing radiotherapy use, achieving a level of treatment in which 80% of the treated population did not require it. A combination of chemotherapy regimens that had not previously been used together was administered. Radiotherapy was only used when the response to chemotherapy was incomplete or when the disease relapsed or progressed. Most patients did not receive radiotherapy following high remission rates after chemotherapy. The relapse rate was remarkably low (5.8%), and these few cases were successfully treated with additional chemotherapy and radiotherapy. Thus, five years after diagnosis, 100% of the patients were alive and lymphoma-free, except for two refractory cases who remained on chronic treatment with a good quality of life despite the persistence of the disease.
This remarkable treatment success was achieved jointly by Garrahan Hospital in Argentina and Pereyra Rosell Hospital in Uruguay, demonstrating the reproducibility of these results across centers.
Hodgkin Lymphoma in children and adolescents
Classical Hodgkin lymphoma is a cancer that attacks the lymphatic system, the network of tissues and organs that defends the body against infections. Approximately 8,700 cases of Hodgkin lymphoma are diagnosed each year in children and adolescents worldwide.
In children and adolescents, the chances of a cure exceed 95% with current treatments, which in many centers around the world still include radiotherapy.
While the application of radiation therapy has been a cornerstone of Hodgkin Lymphoma treatment, it increases the risk of developing new tumors, heart problems, or infertility decades later.
The research
Medical researchers in South America questioned whether this radiation was truly necessary, thus preserving long-term quality of life and reducing early mortality.
They treated children with Hodgkin lymphoma with tailored chemotherapy and achieved complete remission in 86.2%. The research team conducted a clinical trial known as LH-GALOP 2017, the results of which were published in the journal Leukemia & Lymphoma. The trial demonstrated that most of these patients could be treated without radiotherapy without compromising their chances of a cure.
The researchers work at the Dr. Juan P. Garrahan Children’s Hospital in Buenos Aires and the Alexander Fleming Children’s Hospital in Mendoza, Argentina; the Pereira Rossell Hospital in Montevideo, Uruguay, within the framework of the Latin American Group for Pediatric Oncology (GALOP).
They stated that in highly curable diseases, particularly during the early stages of life, the future quality of life has become a more urgent need than the cure itself.
In adults, the impact of radiotherapy is less significant because Hodgkin’s Lymphoma occurs at an older age, and the late effects are either not observed or are not clinically relevant. But in childhood, long-term side effects will occur.
Previous studies had already suggested that omitting radiotherapy in patients who achieved remission of detectable disease with chemotherapy did not affect ten-year survival. The LH-GALOP 2017 protocol adjusted chemotherapy according to risk and treatment response and reserved radiotherapy for selected cases.
The central idea of the trial was simple: to give each patient the right amount of chemotherapy based on their risk and response to treatment, and to reserve radiotherapy only for those who did not achieve disease elimination with medication.
To do this, the researchers divided the patients into three groups , such as low, intermediate, and high risk according to the disease stage at diagnosis.
The treatment combined two well-known chemotherapy regimens: ABVD—doxorubicin, bleomycin, vinblastine, and dacarbazine—and ESHAP—etoposide, methylprednisolone, cytarabine, and cisplatin—both sets of drugs that attack cancer cells.
The novelty lay not in the drugs themselves, but in their combination as a first-line treatment for advanced disease, something that had not been reported before.
Midway through the treatment, doctors evaluated each patient’s response with a PET-CT scan—a tomography scan that detects cancer cell activity in the body—and adjusted the treatment plan accordingly.
Those who responded well received fewer chemotherapy cycles; those who responded slowly received more cycles. The central objective of the protocol was to achieve a high rate of complete, durable remission with a lower risk of late side effects.
At the end of treatment, doctors reassessed the response to decide the use of radiotherapy using PET-CT and the Deauville scale, a tool that scores from 1 to 5 the amount of tumor activity remaining in the body. At that point, radiotherapy was administered only to those patients without a complete remission.
Results with five years of follow-up
The trial included 109 patients aged 2 to 18 years with a recent diagnosis of classical Hodgkin lymphoma, recruited between October 2017 and November 2024.
51% belonged to the high-risk group (advanced stages of the disease) and 46% presented with symptoms, such as fever, night sweats, and unexplained weight loss.
At the end of chemotherapy, 86.2% of patients achieved complete remission, meaning the disappearance of detectable disease. In high-risk patients, this rate was 89.3% (AVBD and ESHAP), compared to 64% achieved by the same group in a previous study using only ABVD.
With nearly five years of follow-up, the overall five-year survival rate was 100%. Event-free survival, which measures how many patients remained alive and free of relapse, was 88.5%.
In total, only 19.3% of patients received radiotherapy, a figure that includes cases that did not fully respond to chemotherapy, relapses, and refractory disease.
Six patients relapsed (5.8%) after a median of 23 months from remission; five of these were in the high-risk group. All received second-line treatments and remained disease-free at the time of analysis.
Of the five refractory cases (4.6%), three achieved complete remission with other therapy options, and two remained alive with active disease while receiving immune checkpoint inhibitors, which activate the immune system to attack the tumor.
Conclusions
The researchers concluded that “our results provide further evidence that radiotherapy in patients who respond well to first-line chemotherapy can be safely omitted.”
They also noted that the combination of ABVD and ESHAP as first-line therapy for advanced disease had not been reported until that time.
The researchers also pointed out that the advent of new drugs such as checkpoint inhibitors and brentuximab vedotin opens the door for further reducing the use of radiotherapy in the future.
The study suggested that the LH-GALOP 2017 protocol, by relying on low-cost conventional chemotherapy, accessible imaging, and restricted radiotherapy, could be a viable option for use in other parts of the world, particularly in low- and middle-income countries.
Reference
Alfaro, E., Schelotto, M., Zamaro, H., Sanchez La Rosa, C., Guitter, M., Romero, C., … & Zubizarreta, P. (2026). Radiotherapy may be omitted in children and adolescents with classical Hodgkin lymphoma in complete remission after frontline risk and response-adapted chemotherapy: a multicenter clinical trial (LH-GALOP 2017). Leukemia & Lymphoma, 1-8. https://doi.org/10.1080/10428194.2026.2662496
