{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T12:08:31Z","timestamp":1785154111616,"version":"3.55.0"},"reference-count":45,"publisher":"Wiley","issue":"15","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Euronet\u2010PHL\u2010C1 protocol has yielded excellent results for pediatric Hodgkin Lymphoma (HL), by omitting radiotherapy (RT) in early responders, thereby decreasing long\u2010term toxicities. However, its application in resource\u2010limited countries remains challenging. This study aims to evaluate patient outcomes using this protocol and the feasibility of omitting RT for early responders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of 87 previously untreated pediatric HL patients at our Center from 2012 to 2022, following the Euronet\u2010PHL\u2010C1 protocol. RT was omitted for patients with an early rapid response at interim evaluation. Collected data were analyzed to determine survival outcomes and predictors of relapse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean age of the patients was 13\u2009years, with 51.7% female. B\u2010symptoms were present in 59.8% of the patients, while 37.9% had bulky disease, 57.1% had elevated erythrocyte sedimentation rate, and 42.5% had stage IV disease. RT was omitted for early rapid responders in 22.9% of the patients. The therapy was generally well tolerated, with only 36 episodes of febrile neutropenia and no treatment\u2010related mortality. The 5\u2010year progression\u2010free survival and overall survival of the entire cohort were 89.3% and 97.6%, respectively. Nine patients relapsed, and two patients died. No independent predictors of event\u2010free survival were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The implementation of Euronet\u2010HL protocol in our center provided excellent outcomes and a safety profile despite a few challenges. While RT can be removed in low\u2010stage, rapid\u2010responder patients, caution persists in resource\u2010limited settings for those with advanced stage or bulky disease, highlighting the need for prospective trials to guide safe RT omission.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71095","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T08:53:52Z","timestamp":1753952032000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Outcome and Challenges in the Treatment of Pediatric Hodgkin Lymphoma With Euronet\u2010\n                    <scp>PHL<\/scp>\n                    \u2010\n                    <scp>C1<\/scp>\n                    Protocol: Experience From a Resource\u2010Limited Country"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6695-3718","authenticated-orcid":false,"given":"Elie","family":"Bechara","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Faculty of Medicine American University of Beirut  Beirut Lebanon"},{"name":"Children's Cancer Institute American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toufic","family":"Eid","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arwa","family":"El\u2010Dhuwaib","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine, Faculty of Medicine American University of Beirut  Beirut 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