Pediatric Hodgkin disease in Brazil: a disease with a highly heterogeneous treatment

Standard of care and protocols for the treatment of pediatric cancer lead to a clear improvement in survival rates and quality of life. Little is known about how these treatments are implemented in Brazil. Our study aimed to evaluate children treated for Hodgkin disease (HD) in south Brazil between 2002 and 2013 through the analysis of medical records in 6 different centers. Results: Fifty-nine children and adolescents were included. The median age was 12 years (range 3-18 years). Male:female ratio was 1.95:1. Localized disease (stage I/II) was observed in 30 patients (50.8%) while the remaining 29 (49.2%) had advanced disease (Stage III/IV). The chemotherapeutic treatment schema was different among services and comprised three different based protocols. ABVD schema was the most frequently used (52 children (88.1%)). The number of cycles was highly variable (4-16 cycles) even at the same clinical stage and with similar clinical response. Conclusion: These data highlight the importance of turning the best practice policies readily available to all pediatric oncologists. Local protocols allow integrative studies among centers that would certainly maintain or improve cure rates, reduce long-term toxicity and evaluate specific biological characteristics of these diseases in our population. For these reasons, we reinforce the idea that standardization of treatment in pediatric oncology is a child health priority and also a viable low-cost strategy to improve care in middle-income countries such as Brazil.