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Chemotherapy in Wilms' tumor
or estrogen therapy experience relief from pain following bilateral adrenalectomy, but whether this is due to elimination of adrenocortical androgens or to corticostrroid replacement therapy remains unclear. Objective regression of the primary tumor or metastases occurs seldom, if at all, and most adrenalectomized patients fail to survive more than one year. Somewhat more encouraging results have been reported following pituitary ablation, particularly in a short-term objective response. Both intrasellar soY, and stereotactic cryohypophysectomy have recently been tried extensively and appear to be as effective as surgical removal of the total gland. Neither adrenalectomy nor hypophysectomy are currently advocated as primary procedures in previously untreated patients, but is reserved rather for those who have relapsed and in whom the disease is progressing actively. Nonhormonal Chemotherapy Alan Yagoda, M.D. Memorial Hospital for Cancer
and Allied Diseases
Many cytotoxic agents alone, or in combination (sometimes with androgens), have been tried with some objective responses from cyclophosphamide, 5fluorouracil, and aniline mustard. Aniline mustard is unique since appropriately stained tumor cells obtained from bone marrow aspirations may be of predictive value. A review of the various cytotoxic agents used in treating prostate carcinoma was presented emphasizing the difficulties in evaluation and the need for random clinical trials.
Pediatric
Urologic
Cancer
Surgical Treatment of Wilms Tumor Willard E. Goodwin, M.D. University of California, Los Angeles, School of Medicine Surgical treatment should be prompt, radical excision of the kidney with all of its attachments, through a generous abdominal incision which also allows inspection of the opposite kidney. It is important not to try to mobilize the kidney and tumor until arterial and venous blood supply have been ligated. The kidney, including Gerota’s fascia and the upper ureter, are removed intact, and lymph nodes are dissected from the diaphragm to the aortic bifurcation. In bilateral disease (4 to 10 per cent) usually one kidney is removed, and the tumor-bearing area in the less involved kidney is marked with silver clips or wire to guide the radiologist for subsequent x-ray therapy. Preoperative irradiation is rarely indicated, but preand postoperative chemotherapy is of definite value. The most useful drugs are Actinomycin D and vincristine. The surgical treatment of nephroblastoma is not an emergency, but it should be performed promptly within a day or two of diagnosis, after chemotherapy is begun.
UROLOGY
/
MAY 1973
/
VOLUME
I, NUMBER 5
_
Chemotherapy in Wilms’ Tumor Wataru W. Sutow, M.D. M.D. Anderson Hospital and Tumor Institute The routine use of adjuvant chemotherapy has improved survival so that now, in favorable cases, a cure rate exceeding 90 per cent can be anticipated. Also, increasing numbers of children with metastatic disease are being saved. Actinomycin-D and vincristine are effective chemotherapeutic agents in treatment of this tumor. The possibility of achieving an additive therapeutic effect by the combination of the two drugs is being evaluated in a national study. The effectiveness of other drug regimens, such as high-dosage cyclophosphamide and adriamycin, remains to be established. Radiation Therapy in Management of Children with Wilms’ Tumor Guilio J. D’Angio, M.D. Memorial Hospital for Cancer and Allied Diseases The role of radiation therapy in the management of children with Wilms’ tumor is undergoing reassessment. The traditional method of treating these patients has included the routine use of postoperative radiation therapy. This has been brought into question recently, and the matter is under investigation by a national cooperative study group. However, radiation therapy undoubtedly is useful in the management of children with metastases. Treatment of Neuroblastoma Alexander H. Bill, M.D. The Children’s Orthopedic Hospital Center, Seattle
and Medical
Neuroblastoma is unusual in that spontaneous regression occurs in a small proportion of the younger patients. Additionally, the disease can be followed by the level of vanillylmandelic acid in the urine, which reflects the amount of tumor tissue. An explanation for the regression has apparently been found. It has been shown in a number of ways by a group of investigators in Seattle that (1) the lymphocytes of the patients and of some family members are lethal to neuroblastoma cells in tissue culture; and (2) possibly more important is the fact that there has been demonstrated a “blocking antibody” in the serum. This blocking antibody evidently protects the tumor cells against the patient’s immune blood cells. Treatment currently is by surgical intervention, radiation, and chemotherapy. The surgical procedure should be carried out to remove as much tumor as possible without loss of function and should be repeated if more tumor appears which can be removed. The judgment as to recurrent tumor is made by following the levels of vanillylmandelic acid, physical examination, and x-ray examination. Radiation Therapy in Neuroblastoma Guilio J. D’Angio, M.D. Memorial Hospital for Cancer and Allied Diseases The role of radiation therapy in the management of patients with neuroblastoma remains to be defined
495
and Allied Diseases
Many cytotoxic agents alone, or in combination (sometimes with androgens), have been tried with some objective responses from cyclophosphamide, 5fluorouracil, and aniline mustard. Aniline mustard is unique since appropriately stained tumor cells obtained from bone marrow aspirations may be of predictive value. A review of the various cytotoxic agents used in treating prostate carcinoma was presented emphasizing the difficulties in evaluation and the need for random clinical trials.
Pediatric
Urologic
Cancer
Surgical Treatment of Wilms Tumor Willard E. Goodwin, M.D. University of California, Los Angeles, School of Medicine Surgical treatment should be prompt, radical excision of the kidney with all of its attachments, through a generous abdominal incision which also allows inspection of the opposite kidney. It is important not to try to mobilize the kidney and tumor until arterial and venous blood supply have been ligated. The kidney, including Gerota’s fascia and the upper ureter, are removed intact, and lymph nodes are dissected from the diaphragm to the aortic bifurcation. In bilateral disease (4 to 10 per cent) usually one kidney is removed, and the tumor-bearing area in the less involved kidney is marked with silver clips or wire to guide the radiologist for subsequent x-ray therapy. Preoperative irradiation is rarely indicated, but preand postoperative chemotherapy is of definite value. The most useful drugs are Actinomycin D and vincristine. The surgical treatment of nephroblastoma is not an emergency, but it should be performed promptly within a day or two of diagnosis, after chemotherapy is begun.
UROLOGY
/
MAY 1973
/
VOLUME
I, NUMBER 5
_
Chemotherapy in Wilms’ Tumor Wataru W. Sutow, M.D. M.D. Anderson Hospital and Tumor Institute The routine use of adjuvant chemotherapy has improved survival so that now, in favorable cases, a cure rate exceeding 90 per cent can be anticipated. Also, increasing numbers of children with metastatic disease are being saved. Actinomycin-D and vincristine are effective chemotherapeutic agents in treatment of this tumor. The possibility of achieving an additive therapeutic effect by the combination of the two drugs is being evaluated in a national study. The effectiveness of other drug regimens, such as high-dosage cyclophosphamide and adriamycin, remains to be established. Radiation Therapy in Management of Children with Wilms’ Tumor Guilio J. D’Angio, M.D. Memorial Hospital for Cancer and Allied Diseases The role of radiation therapy in the management of children with Wilms’ tumor is undergoing reassessment. The traditional method of treating these patients has included the routine use of postoperative radiation therapy. This has been brought into question recently, and the matter is under investigation by a national cooperative study group. However, radiation therapy undoubtedly is useful in the management of children with metastases. Treatment of Neuroblastoma Alexander H. Bill, M.D. The Children’s Orthopedic Hospital Center, Seattle
and Medical
Neuroblastoma is unusual in that spontaneous regression occurs in a small proportion of the younger patients. Additionally, the disease can be followed by the level of vanillylmandelic acid in the urine, which reflects the amount of tumor tissue. An explanation for the regression has apparently been found. It has been shown in a number of ways by a group of investigators in Seattle that (1) the lymphocytes of the patients and of some family members are lethal to neuroblastoma cells in tissue culture; and (2) possibly more important is the fact that there has been demonstrated a “blocking antibody” in the serum. This blocking antibody evidently protects the tumor cells against the patient’s immune blood cells. Treatment currently is by surgical intervention, radiation, and chemotherapy. The surgical procedure should be carried out to remove as much tumor as possible without loss of function and should be repeated if more tumor appears which can be removed. The judgment as to recurrent tumor is made by following the levels of vanillylmandelic acid, physical examination, and x-ray examination. Radiation Therapy in Neuroblastoma Guilio J. D’Angio, M.D. Memorial Hospital for Cancer and Allied Diseases The role of radiation therapy in the management of patients with neuroblastoma remains to be defined
495