[Progress in the treatment of children with Wilms' tumor in the Department of Pediatric Oncology at the Institute of Mother and Child]. / Postepy w leczeniu guzów Wilmsa u dzieci w Klinice Onkologii Dzieci i Mlodziezy Instytutu Matki i Dziecka.

A retrospective analysis of treatment results of 242 children with Wilms tumor treated in the years 1962-1989 is presented. The patients (pts) were divided into 4 groups according to methods of treatment that changed with the time. Group I consisted of patients treated between 1962-1965. Surgery followed by radiotherapy (RTX) and monochemotherapy (CHT) (ACTD) were the main treatment methods. Group II consisted of 68 patients treated between 1966-1974. In this group, surgery was followed by RTX and CHT (multiple courses of ACTD + VCR). Group III included 68 patients treated between 1975-1982. Preoperative RTX (20 Gy) and CHT (ACTD) were administered. RTX (total 35 Gy) and adjuvant CHT were continued after surgery. Group IV consisted of 62 patients treated in 1982-1989. Preoperative CHT (ACTD, VCR +/- ADR) was introduced. Adjuvant treatment depended on stage and histology of the tumor. The treatment results were as follows: 27, 66.1, 38.2 and 85.4% of survival, respectively. This points to the beneficial role of induction CHT, delayed surgery with adjusting the intensity of further adjuvant treatment to stage and tumor histology.

[Progress in the treatment of 155 children with rhabdomyosarcoma obtained in one center between 1962-1990]. / Postep w leczeniu rhabdomyosarcoma uzyskany w jednym osrodku u 155 dzieci w latach 1962-1990.

The results of treating 155 children with rhabdomyosarcoma using protocols that (RMS) changing over the years between 1962-1990 in reported to progress in chemotherapy (CHT), introduction of megavoltage radiotherapy (RTX) and conservative surgery with attempts to preserve vital organs are presented. In the first period between 1962-1980 when mainly surgery was applied with orthovoltage RTX and low intensity CHT, only 20 of 74 children (27%) survived. In the second period 1981-1985 systemic CHT containing new cytostatic, megavoltage RTX and limited surgery applied in advanced cases after induction of CHT were introduced. Nineteen of 46 children (41.3%) survived. In the last period a 1986-1990 more intensive CHT with an own modified protocol VACA/VAIA and intensification phases containing cisplatinum, etoposide and/or carboplatinum were introduced. Twenty seven of 35 patients (60%) survived. Comparative analysis of the last two periods pointed to significant progress in treatment in III clinical group (IRS classification), (20.7% vs 62.9%) and parameningeal RMS (0% vs 58%). Meaningful improvement concerned also young children below 5 years of age (42.8% vs 73.9%). The main prognostic factors and treatment failures of the recent years were analyzed.

[Preliminary evaluation of individualized use of large doses of methotrexate for treatment of osteosarcoma in children and adolescents]. / Wstepna ocena zastosowania indywidualizowanych duzych dawek metotreksatu w leczeniu miesaka kosciopochodnego u dzieci i mlodziezy.

To improve the final treatment results in children with osteosarcoma, we applied after French DD-11 protocol HD MTX increasing with the younger age of patients, modified next on the basis of maximal serum drug concentrations (Cmax) as feed-back dosing. Toxic side effects were analysed according to WHO grading correlated with MTX elimination. We administered 39 HD MTX courses in 13 patients with osteosarcoma: aged 7-20 yrs (median 12 yrs). We performed 301 measurements of MTX concentration using the method of fluorescence polarisation. Therapeutic Cmax of 1000 microM/L and higher were obtained in 20 courses, the mean of lower values was 770 microM/L. We modified the next MTX doses in 23.7% of courses. Drug elimination was good in the majority of cases: in 34 of 39 courses at 24 hrs, in 36 of 39 at 48 hrs. Nevertheless, III and IV degree toxic side-effects accompanied about half of the courses and could not be predicted by MTX serum level measurements. HD MTX therapy with monitoring MTX serum levels proved feasible with acceptable toxicity. Therapeutic MTX levels were obtained in about 60% of cycles in patients with a favourable course of the disease in comparison with 25% in patients with an unfavorable course but the beneficial effect of age-tailored MTX and feed-back dosing on the treatment results will be possible to assess in the next 3 years.

[Role of chemotherapy in treatment of osteosarcoma]. / Rola chemioterapii w leczeniu miesaka kosciopochodnego.

The paper is dedicated to various forms of chemotherapy used in osteosarcoma from the very beginning in '70-ties, when only one drug treatment was applied through the following 20 years full of assays and clinical trials, which finally proved the necessity of multidrug chemotherapy in all cases of osteosarcoma. The introduction of crucial neoadjuvant chemotherapy with exemplary Rosen programme T-10 which enabled the progress of conservative limb-salvage surgery and experience with this programme of many national groups are discussed.

[Alternative chemotherapy of malignant bone neoplasms in children]. / Alternatywne leczenie chemiczne nowotworów zlosliwych kosci u dzieci.

The authors propose alternative chemotherapy of osteosarcoma and Ewing's sarcoma in children. The aim of this proposal was elaboration of effective and, at the same time, less expensive and less toxic therapeutic regimens. The authors recommend open surgical biopsy with doxorubicin for 3 consecutive days as a protection against the released circulating neoplastic cells. After completion of histopathologic examination, one of two types of chemotherapy is chosen randomly. In osteosarcoma, there was induction chemotherapy for 4 or 9 weeks (according to the type of operation--conservative amputation or limb salvage surgery). In the I type of induction chemotherapy, high doses of methotrexate with vincristine and citrovorum factor rescue are administrated weekly, in the II type--the combination of BCD (bleomycin, cytoxan, actinomycin D) and CDDP (cisplatin). On the regimen of intensification chemotherapy decides the degree of tumour response to induction chemotherapy assessed as tumour necrosis in histopathologic examination. Maintenance chemotherapy is the same in two types of regimen and is continued for the period up to 2 years. The authors elaborated concomitantly the regimen of high methotrexate doses administration with rescue procedure in the case of elevated serum methotrexate levels, and regimen of cisplatin administration aiming at maximal patients protecting against the toxic effects of both drugs. In Ewing's sarcoma the randomisation differentiates between T-9 Rosen's regimen of chemotherapy and own modification of Memphis group regimen. The primary tumour is treated by radiotherapy with lower doses adjusted to the tumor response to induction chemotherapy (30-50 Gy or 50 Gy) and the irradiation port limited to the residual bone lesion plus a 2-3 centimeter margin. Surgical excision of bone with tumor depends on special tumor localisation as the clavicula, rib or fibula. The results of discussed treatment regimens will be subsequently published.

[The spinal cord compression syndrome in children with mediastinal neuroblastoma]. / Zespól ucisku rdzenia w neuroblastoma sródpiersia u dzieci.

The authors present 5 cases of mediastinal neuroblastoma in children with the syndrome of medullar compression. The problems of the diagnosis, the treatment and the prognosis are discussed. The attention is called to the rapidity of neurological signs progression and the diagnostic significance of cerebro-medullar fluid and radiological examinations (thoracic and vertebral X-rays and myelography). The necessity to decompression (laminectomy) as quick as possible is underlined. The authors indicate that these cases must be evaluated and treated in the complex way and the tumour advancement, neurological disorders, appropriate orthopedic supplies and rehabilitation must be considered respectively. The serious prognosis, especially in children above one year of life, is emphasized.

[Value of polychemotherapy in the treatment of children with neuroblastoma]. / Ocena wielolekowej chemioteraph w leczeniu neuroblastoma u dzieci.

The authors present a group of 10 children with neuroblastoma treated with multidrug chemotherapy. 5 children were treated according to VCAD protocol and 5 children according to COMP protocol. The VCAD protocol seems to be useful in less advanced stages of neuroblastoma (stage I and II after incomplete excision) as a prophylactic chemotherapy and in stage III with parallel irradiation of tumoral mass. Chemotherapy with COMP protocol can provoke palliation and prolongation of survival time, and sometimes significant remission. Having support of the treatment with adequate irradiation it is possible to restrict tumoral mass and consolidate the result od chemotherapy.

[Sacrococcygeal teratomas in children treated at the Oncological Clinic of the Mother and Child Institute in Warsaw]. / Potworniaki okolicy krzyzowo-guzicznej u dzieci w materiale Kliniki Onkologii Dzieci i Mlodziezy Instytutu Matki i Dziecka w Warszawie.

During the years, 1962 through 1975, 27 children with sacrococcygeal teratomas were seen at the Oncological Department of the National Research Institute for Mother and Child in Warsaw. 13 teratomas were benign and 14 were malignant. Surgical removal through a sacral approach was the basis of the treatment. In the presacral tumors with great diameter two-phase method was performed (the first phase--trans-abdominal excision of the tumor and the second phase--excision of remnant tumor's pedicle with coccygeal bone resection). Monodrug chemotherapy (Cyclophosphamide, Actinomycin D) in malignant tumors was without effect. In the group of benign teratomas are alive 11 children, in the group of malignant teratomas only one child survived. Some profits are expected from the multidrug chemotherapy ( Methotrexate , Cyclophosphamide, Actinomycin D) associated with radiotherapy, this can make operable primarily inoperable tumors.

[Chemotherapy of bladder and prostatic neoplasms in children]. / Chemioterapia nowotworów pecherza moczowego i gruczolu krokowego u dzieci.

The basic informations concerning pathology and clinical stagging of malignant tumours localized in urinary bladder and prostatic gland are introduction to proper presentation of own material collected and treated in the years 1962-1977. The material consists of 23 cases of rhabdomyosarcoma localized in minor basin. Formerly in the years 1962-1975, the basic form of treatment was surgery with/or radiotherapy. Chemotherapy that was given accidently in special indications as single dose or for a short time. Since 1975, we have started with systematic multidrug chemotherapy (VAC) used as an important part of complex therapy. Finally the authors discuss the place of chemotherapy in complementary treatment on the base of the literature and their own experience.