ISSN:0098-1532    

DOI:10.1002/mpo.2950150502

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY

摘要:

AbstractCytoreduction for hyperleukocytosis before the initiation of primary therapy may reduce morbidity and mortality from blast cell lysis in children with acute lymphoblastic leukemia (ALL) and from leukostasis in children with acute nonlymphoblastic leukemia (ANLL) or chronic myelogenous leukemia (CML). The clinical features of 35 children (23 with ALL, 5 with ANLL, and 7 with CML) who underwent cytoreduction before the institution of definitive therapy were studied. Twelve children had exchange transfusions and 23 underwent leukaphereses. The cytoreductive procedures were equally effective in removing peripheral leukocytes (median decrease, 60%) and produced no complications. Ten children required additional cytoreduction because of further leukocyte increase before chemotherapy became effective. Three children with ALL who had renal insufficiency and metabolic derangement prior to leukapheresis sub‐sequently required additional therapeutic measures. Three children with respiratory symptoms attributable to leukostasis improved after cytoreducation, and there were no episodes of intracerebral hemorrhage. These observations demonstrate the safety and efficiency of exchange transfusion and leukapheresis, and provide support for the role of cytoreduction in the early management of cases of hyperleukostasis and leukemia in childre

ISSN:0098-1532    

DOI:10.1002/mpo.2950150503

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY

摘要:

AbstractSeven children with neuroblastoma who had relapsed on or after conventional therapy (3 originally stage IV, 3 stage III, 1 stage II) were entered on a study of “massive therapy” with purged autologous bone marrow rescue. In 5 patients attempts were made to reinduce remission with alternative chemotherapy, and a partial or complete response was achieved in 3. The massive therapy regimen comprised melphalan, vincristine, and total‐body irradiation. Of 6 patients with measurable disease, all showed objective response to high‐dose therapy (5 partial, 1 complete remission), but the median duration of remission was only 5 months (range 1/2 to 10). One patient remains disease‐free at 18 months post graft. This patient was the only one treated in second complete remission. These data confirm the high response rate achieved by high‐dose melphalan, total‐body irradiation regimens, but it appears unlikely that a single high‐dose chemoradiotherapy procedure will cure patients after relapse, particularly if they are unresponsive to conventional salvage regimens. Such protocols may, however, have a role as consolidation in first remission. The use of double‐autograft procedures is an alternative that warrants further investigation in patients with relap

ISSN:0098-1532    

DOI:10.1002/mpo.2950150504

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY

摘要:

AbstractIncreasing numbers of children with cancer, including those with acute lymphocytic leukemia and medulloblastoma, are experiencing long‐term disease control. As survival increases, so does the recognition that the treatment used to prolong survival may have significant detrimental effects on the central nervous system (CNS). Because of the slow replication rate of most constituents of the CNS, these effects tend to be delayed. Radiotherapy, and to a lesser extent, chemotherapy (primarily methotrexate) have been implicated in the causation of such sequelae. The pathogenesis of CNS damage is only partially understood and evidence suggests that direct effects on intracranial endothelial cells and brain white matter and immunologic mechanism play a role. A spectrum of clinical syndromes may occur, including radionecrosis, necrotizing leukoencephalopathy, mineralizing microangiopathy with dystrophic calcification, cerebellar sclerosis and spinal cord dysfunction. The two most common forms of sequelae are neuropsychological and neuroendocrinologic damage. The frequency, degree of and etiology of neurocognitive dysfunction is less than completely elucidated. Radiotherapy has been implicated as the major cause of damage, but the relationship between radiotherapy and the type of damage caused and the volume and dose of radiotherapy and degree of cognitive damage is unclear. Cognitive deficits are progressive in nature. Younger children are more likely to suffer the severest damage; but no patient of any age is free of risk of damage. Growth hormone impairment is the most common form of neuroendocrinologic dysfunction. There is increasing evidence that children with cancer who are long‐term survivors are at increased risk for the development of secondary CNS tumors; possibly due, in part, to previous treatment. Much work needs to be done to characterize the sequelae which may occur, develop means of earlier detection, investigate ways to ameliorate sequelae and devise less toxic treatm

ISSN:0098-1532    

DOI:10.1002/mpo.2950150505

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY

摘要:

AbstractWhile the proportion of patients with Ewing's sarcoma attaining and maintaining long‐term remission has markedly improved, a proportion of patients suffer relapse of the tumor. In our experience relapses may occur late in the course of the disease, approximately 20% of those at risk beyond 5 years having recurrence of tumor.Review of our data indicates that for patients relapsing after therapy has been discontinued, the probability of attaining second remission is high (0.84) and that a significant proportion of these patients attaining second complete remission will survive their disease (0.60

ISSN:0098-1532    

DOI:10.1002/mpo.2950150506

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY

ISSN:0098-1532    

DOI:10.1002/mpo.2950150507

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY

摘要:

AbstractRetroperitoneal sarcomas are a varied group of malignancies which have a high rate of recurrence following surgery alone. The majority of the initial recurrences are local in nature, and new therapeutic approaches are clearly needed. Diagnostic imaging and “interventional radiology” have important roles to play in the management of these malignancies, as well as in investigational approaches to therapy. Two cases are presented which illustrate some recent advances in diagnosis and staging of this group of tumors which can be attributed to new cross‐sectional imaging techniques, when used in concert with “conventional” imaging methods. The latter include arteriography to guide the placement of intra‐arterial catheters for local infusion chemotherapy. CT‐guided needle biopsies can be performed to secure a preoperative diagnosis and also to obtain viable tissue for in vitro chemosensitivity assays. A judicious combination of local and systemic chemo therapy, radiation, and surgery may hold promise for better control of this malignancy, similar to the therapeutic advances which have already been obtained with

ISSN:0098-1532    

DOI:10.1002/mpo.2950150508

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY

摘要:

AbstractA case is presented of an embryonal sarcoma of the liver in a young child. The differential diagnosis of liver masses in children is reviewed, as well as the implications of diagnostic imaging studies for diagnosis, prognosis, staging, and the choice of treatment. The use of diagnostic imaging for guiding interventional diagnostic procedures and certain palliative approaches is also discussed.

ISSN:0098-1532    

DOI:10.1002/mpo.2950150509

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY

摘要:

AbstractI Despite the tremendous progress that pediatric oncology has achieved in the treatment of Wilms' tumor over the last several decades, survival rates in our institution before 1970 did not exceed 8%. In order to correct the problem standardized therapy was instituted in 1970 through a multimodal oncological team. Results using the new approach were reviewed in 1979 (50 patients) and showed an overall 34% 2‐year survival rate. Although encouraging, these results were still far below the ones reported in the literature. This prompted us to use a vigorous professional and lay educational program in the city. Treatment methods were replaced by those advocated by the Second National Wilms' Tumor Study. A second evaluation period initiated in 1979 and extended through 1984 (35 patients) yielded an overall 83% survival rate. A retrospective study of the two periods by univariate and multivariate survival analysis revealed that, although much of the improvement in survival could be attributed to a shift in stage distribution towards earlier disease, the admission period itself had an important additional explanatory effect with respect to survival. This was probably due to the improvement in treatment protocols used in the latter period. Age was a prognostic variable only for patients admitted during the 1979‐1984 per

ISSN:0098-1532    

DOI:10.1002/mpo.2950150510

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY

摘要:

AbstractA 10‐year‐old boy with precocious puberty of 2 1/2 years' duration presented with a malignant thoracic teratoma with elevated levels of beta human chorionic gonadotrophin (β‐HCG) and alpha fetoprotein (αFP). The mediastinal tumor was completely excised and adjuvant chemotherapy commenced. Within 3 weeks of commencing chemotherapy he developed hematologic abnormalities that, with the subsequent clinical illness, led to a diagnosis of malignant histiocytosis. Death occurred a few days after start of therapy for malignant histiocytosis. Cytogenic studies showed the somatic karyotype to be that of Klinefelter's sydrome, while the malignant cells in marrow and lymph node carried an additional marker chromosome. This case, with others reported, suggest that the XXY karyotype may influence the development of mediastinal germ cell tumors, which in themselves appear to be associated with the early onset of a malignancy of the hemopoietic

ISSN:0098-1532    

DOI:10.1002/mpo.2950150511

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1987

数据来源: WILEY