Wilms' tumor: analysis of thirty cases.

Thirty cases of Wilms' tumor who had been treated at the Ramathibodi Hospital from January 1970 to December 1982 were analysed retrospectively. There were 14 boys and 16 girls, aged 6 months to 7 years (mean age was 2 years). The right kidney was involved in 12 cases, the left side involvement in 18 cases. Other than the abdominal mass, the common signs and symptoms were hematuria (30%) and hypertension (13.3%). The congenital anomalies were found in 2 cases. There was an increase in VMA in three of the six cases determined for VMA:creatine ratio and VMA in 24 hours urine. Seven cases (23.3%) had nephrectomy done in other hospitals. Ninety percent of the patients came in with the stage II-IV, only 10% had stage I. The treatment consisted of surgery, radiation therapy, actinomycin-D, vincristine and adriamycin. Eight patients (26.6%) were lost to follow-up. The cure rate in stage II, III and IV were 71.4%, 50% and 29% respectively. The serious surgical complications include a case of shock due to excessive bleeding and another case of sudden death during the operation due to the tumor emboli from the inferior vena cava to the main pulmonary and both bronchial arteries.

Rhabdomyosarcoma in Thai children.

Twenty-six cases of rhabdomyosarcoma diagnosed from a total of 845 Thai children with childhood malignancy who had been treated at the Department of Pediatrics Ramathibodi Hospital, from May 1970 to December 1982 were analyzed retrospectively. There were 16 boys and 10 girls, aged 3 months to 13 years old (mean age was 5.6 +/- 4.1 years old). The common type was the embryonal cell sarcoma (19 cases), 3 cases were undetermined, 2 cases of alveolar cell type and one each of the pleomorphic and undifferentiated cell type. Only 2 cases had stage II disease, 10 and 14 cases were stage III and IV respectively. The common locations were head and neck (10 cases), abdomen (8 cases including one in the uterus, scrotum and 3 in the urinary bladder), and in 7 cases in the extremities. One patient had small lesion at the buttock. The treatment consisted of surgery, radiation therapy, actinomycin, vincristine and cyclophosphamide. Eight cases were lost to follow-up, 10 cases were discharged in advanced stage after been treated for 6.2 +/- 4 months, 4 cases had no evidence of disease for 2 to 7.5 years, 4 cases died after 4 to 27 months of treatment. The poor result obtained was probably due to the late stages of the disease at diagnosis, and limitations in the use of effective medications.

Challenge of the two neural tumors: neuroblastoma and retinoblastoma.

Fifty cases of neuroblastoma and 29 retinoblastoma patients who had additional chemotherapy were analyzed retrospectively. Male:Female ratio were 1:1 and 0.8:1, the ages ranged from birth to 14 years (4 +/- 3.42 year) for neuroblastoma, and one month to 5.5 years (2.4 +/- 1.4 year) for retinoblastoma. More than 70%-90% of them came in advanced stages. The treatment consisted of surgical resection, enucleation or exenteration if feasible. Radiation therapy and chemotherapy were given as specific and palliative measures. All of the neuroblastoma who were younger than 8 months old survived long-term. Various chemotherapeutic agents did not seem to effect the outcome of the advanced cases of these two diseases. The retinoblasts did not seem to be sensitive to MTX and Ara-C. Thio-tepa intrathecally seems to be worth trying. Since these two tumors are not sensitive to treatment and are still a great challenge to the developed countries, awareness of the diseases, early diagnosis and early treatment are appropriate approaches for the developing countries.