[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.