Nephroblastoma stage IV

Abstracts were recognised.

55. WILMS’

TUMOLIR

TIONAL

SOCIEN

Fa

the Trial

(WT)

J.de

(RT)

mndwnisotion

.

P.A.

Kmker,

Four studies were mdiothempy

conducted.

Fr~m this S~IQ in single

free survivol lhe record

versu* multiple

o prafare~~

pre-op.

85% respedively. with

unfavouroble receive

mndomised

in respectively

Stage II with

of stage. CT.

theropy with

* 70%.

paitive

ore mndomised

in respectively

in mointenonce

CT.

15

and AD.

and a.s.

of 84%.

were:

were 76%,

are rondcmised lymphnodes

50%

in correlation

and recurrence

with the whole

free survi-

series of SIOP

it was possible

to recognise

as a clinicopathological

entity with

this favo-

rable prognosis.

W%, of the

to 22%

58.

of the patients in the diagnceis SIOP

no. 6

Stage I potients concerning

are

CT.

post--.

VCR and odding

adriamycin is 6 months.

113 were suitabla

fa

trial.

CISPLATIN IN THETREATMENT OF RECURRENT WILMS' TLMOR. A.T' Meadows. J.Wilimas, J.Champion,J.Belasco, Children's Hospi-tal Cancer Research Center, Philadelphia.Pennsylvania,and Hospital, Memphis, Tennesthe St. Jude Children's Research see,

U.S.A.

Thirteen

ond stage 111 patients

in the last 2 groups

were registaed,

to drow conclusions.

factors

fibroade-

studying

included. 66%;

50%

In the 4th WT study AD and VCR.

CT

After

The 3rd WT study SIOP

gives no problem

intensified

Maintenonce

subtype

(VCR)

3 months and 6 months mointenance

lymphncdes

survival

Nephroblastomas,

Recumnce

(a.s.)

actuarial

val in comparison

watment.

161 patients

and a.s.

histology.

RT yes or no. Stage II with

1982 207 potients

and histological

with

had a stage I tumour capared

pre-ep.CT

negative

of 79%

This is o graat odvontage,

all patients

clinical

RT. A second

is just as goed as pre-cp.RT.

do nat need RT at 011. Pre-cp. of so-called

Q r.f.r.

r.f.s.

thempy

surgery.

pre-cpemtive

6 months to

vinvistine

irresfxxtive

Pm-ap.CT

pre-op.

immediate

is tos early

survival

those *een in fibro-

of the ovary this type is called: type of nephroblastoma.

p+9.

(CT)

RT to pre-op.

Fw the CT arm ond the RTarm

April

actuarial

of the likeness of the with

nomatous

courses of actinomycin

found fa

W(II

chemothew+y

is enough

compared

adenoma

M. Perry,

cowses AD wen found.

could be found with

6 months CT

potients

by pat-op.

Because

structures

1971-1982.

H.J.

ene concerning

study WOI non-rondomiseded. It concemed

NO differente

with

(SIOP)

histological

Villejuif/Paris.

The fint

to multiple

THE INTERNA-

Tournode,

surgery followed

being ?? 50%,

(r.f.s.)

months of maintemnce

no.5

M.F.

Amsterdam,

to direct

FROM

ONCOLOGY

Vo&e,

was doneinsingle

NO diffennce

STUDIES

OF PAEDIATRIC

Camnittee:

J. Lemerle,

D (AD)

TRIALS AND

It

The study goes on. The conclusionfrcm

al1 the studies is: centmlized treotment of this rare diseose in children is necessary. Re-CQ. CT should be given to all patients with (t WT.

56.

NEPHROBLASTOMASTAGE IV. For the Trial Committee:J.de Kralrer, p.Bey, D.Bf&er, M.Carli, C.Nihoul-Fékété,P.A.Voûte, J.Lemerle.Amsterdam,Villejuif/Paris. Under supervisionof the organisingcormnittee of the "ephroblastomatrials and studies of SIOP, s multi-center pilot study was designed. In this study the definitionof Wilms' tumour stage IV patients wil1 be .restrictedto those with haematogenouslung metastasesat presentation.Rationals for the study were: & The stil1 unfavourableprognosis of patients with stage IV disease.0 The need for a more uniform treatmentprotocol,2 To study the possibilityof cutting on lung irradiationin some of these patients. To reach this, it ~8s decided to initiallyintensifythe pre-operativechemotherapy (CT). This vil1 consist of Actinowcin D (AD) 15 unr/ hg/i.v. day 1, 2, 3 - 15, 16, 17 - 29, 30,.31. Vincristin _ (VCR) 1.5 ma/m'/i.v. once B week for 6 weeks. and Adriamvcin (AZ)R)25 mg/m2 dsy 8, 22 > 36. After nephrectómy,metaststectomy wil1 be considered.Pcstoperativetreatmentuil1 depend on the fact if metastaseswe stil1 demonstrableand the local stage of the tumour. Lung irradiationis necessary I" case of incompleteresected or inoperablemetastases. In case of B local stage 11 tumour vith positive lymphnodesoi stage II!, radiotherapyis given to the abdomen according to the protocol SIOP VI. PostoperativeCT wil1 consist of AD 15 ugr/ hg for three consecutivedays and VCR 1.5 mg/m2 once a week for at least 4 weeks. Maintenancetherapy wil1 be the s~me for al1 the patients.To start with VCR 1.5 mg/m'/i.v.and ADR 50 mgjm'li.v. four times with a three week interval followed by 5 courses AD 15 ugr/kg/i.v.5 days and VCR 1.5 mg/m' i.v. day 1 and day 5 every 3 weeks. Besides actuarial and disease free survival,cardiotoxicityand ether treatment related sequelaevil1 be of special concern.

patients received cisplatin for recurrent or unrespo"siveWilme' tumor and 3 of the 12 who were evaluable The inevaluablepatient had transtentand partial responses. was a 6 year old female with recurrent pulmonary metastases who died hours after the infusion. Al1 had received Víncristine, Actinomycin D and Adriamyci" prior to the administration of cisplatinand most had received pulmonary and abdomi"al irradiation. Two patients demonstratedpartial clearing of pulmonary metastases which lasted for 2 and 3 months, while ene patient had P decrease in the size of bis abdominal rec"rre"ce. This lasted 3 months but grew back jusc prior to a scheduled laparotomy for removal of the residual tumor. The dose of cisplatinused was fairly uniform: 90 mg/m' or 1 mglkg. The characteristicsof these patients differed somewhat from the usual populatíon of Wilms' tumor patients; 8 were 111 or male and 4 were female. The majority (9) were Stages

It is noteworthy that while the media” age IV at diagnosis. of the patients was 4 years, the 3 patients vith early stage disease in fhis groq were 7, 9 and 14 years of age. In addition, of the 3 patíents vith unfavorable histologie types, tvo were the only black patients and ene was a 13 month old white male. We conclude that cisplstín may have some efficacy in the therapy of Wilms’ of its use earlier in the tumor and studies pro~ression of disesse should be coneidered. Supported in part by a grant from the National Institutesof

Health (CA 14489).

59. IS

TOTAL

NEPHRECTOMY

TREATMENT

OF

J.Valenca

M.Sousinha. -

Qus!roz.

Clinlca

tituto

Português

Llsboa

-

It

has

to

lignant

AOVISABLE

.

! de

THE

MertinS.

Sousa,M.A.Picanco.

Oncolöglca de

IN

A.Gentll

Oncologia

32.

IV

[Pediatria),

de

Francisco

InsGentil.

Portugal.

been

world'

ALWAYS

NEPHROELASTOMA

standard

perform

policy

total

tumors

of

almost

al1

over

mp~rournterectomy

the

ktdney,

the

for

mainly

for

md-

nephro-

blastoma. Oue

to

advances

results

in

obtained

technically

chematherapy

we

felt

possible

to preserve

the

[

and

it

the

impraved

justified,

section

on

non-involved

whenever

normal

pratian

1

tissues

of

the

kl-

dney. Of

d

of

total

performed

[

80

nephrectamies and

3,.

J.F.M.Delemarre, S.I.O.P.

TYPE OF NEPHROBtASTOMA.

B.Sandstedt,

Nephroblastoma

Emma Kinderziekenhuis,

M.F.Tournade,

Trial and Study, 1018 HJ

secretary:

Amsterdam,

there to

The

tha

After

revision

of the microscopical

sections

of

from the files of the SIOP Nephroblas-

toma Study and Trial

25 cases of a special

wàs

10

1.

These

in

ene

10 case

local

fellow-up

1

wlth

in

in cass

"ear

biiateral

metastases.

Al1

4y, 8

This

latter

[

tumor ethers

12

díed? are

kidneyl. 3y.

2y(r31.

harseshoe

kidney

patient

has

hemi-

tumor

horseshoe

6y. of

recurrence.

had

bilateral a

By,

the

heminephrectomy

+or

recurrence

respectlvely Only

had

oatients

1

and

died so

wbs

far

lost

onlv

from

the

pblma-

alive

and

well. We fel1 that there is a ces8 to be conservative

Netherlands.

889 patients

is

lw.

patient nary

for

up

lY(X21.

for the

[

another

Fellow

THE FIBROADENOMATOUS

patients

10%

subtype

in

surgical polar

recurrence of

tumor

trsatmsnt

tumors. if

with surgery

ressection.

of na

Nephroblastoma, increased

respects

risk the

basic

namelly of

local

principles

In