Primary chemotherapy with or without radiation therapy and/or surgery for children with localized sarcoma of the bladder, prostate, vagina, uterus, and cervix: a comparison of the results in Intergroup Rhabdomyosarcoma Studies I and II

Article Abstract:

A review of cases of children with cancer in or near the bladder revealed that children with complete surgical resection of the surrounding area enjoyed only a marginal increase in survival over those who received chemotherapy as a primary treatment. Only a quarter of the surgically treated patients who were alive at the end of two years still had their bladder, however. Since the loss of the urinary bladder has significant physical and psychosocial effects, an attempt was made to determine if more aggressive chemotherapy might permit a greater number of children to retain at least a portion of their bladder. A total of 109 children with genitourinary sarcomas were treated in an uncontrolled study in which the individual physician made the therapeutic choice for each patient with the objective of saving the bladder, if possible. The chemotherapeutic regimen consisted of vincristine, dactinomycin, and cyclophosphamide. Radiation and/or surgery was used to treat residual or recurrent tumor. While the three-year survival rate was comparable to a previous study in which the treatment was primarily surgical, the disease-free survival was worse (52 percent compared with 70 percent for the surgically treated patients). After three years, only 22 percent of the surviving patients with bladder or prostate cancer still retained their bladders, which is not significantly different from the 23 percent who retained their bladders with surgery as the primary treatment. The evidence, therefore, suggests that present chemotherapeutic techniques are not effective in permitting the preservation of bladder function in children with genitourinary sarcomas. This does not preclude the possibility that improved chemotherapeutic regimens may make bladder preservation possible. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Cancer in children, Childhood cancer, Rhabdomyosarcoma, Sarcoma, Urologic surgery, Genital cancer, Urogenital cancer, Bladder

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The intergroup study of Hodgkin's disease in children: a study of stages I and II

Article Abstract:

A total of 228 previously untreated children with Hodgkin's disease were treated at two cancer centers. At one, the patients were randomly assigned to receive either radiotherapy of the involved field alone, or radiotherapy of the involved field with chemotherapy. At the second center, patients received either extended-field radiotherapy alone or involved-field radiotherapy with chemotherapy. In both cases the chemotherapy consisted of six courses of mechlorethamine, vincristine, prednisone, and procarbazine. Five years after treatment, the groups which received adjuvant chemotherapy in addition to involved-field radiotherapy had significantly better relapse-free survival, at 97 percent and 93 percent at the two centers. However, despite having more relapses, the two groups receiving radiotherapy alone had a comparable overall five-year survival to those receiving adjuvant chemotherapy. In this study the extended-field radiation alone was superior to the involved-field radiotherapy for relapse-free survival at 67 and 41 percent respectively, but the patients were not randomized between the two centers conducting the study. Since the overall survival was not significantly changed by the chemotherapy, the benefits of remaining relapse-free must be weighed against the disadvantages of chemotherapy, including sterility and infection, in deciding on the appropriate course of treatment for Hodgkin's disease in children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pediatric diseases, Hodgkin's disease in children

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Treatment of lower torso Stages I and II Hodgkin's disease with radiation with or without adjuvant mechlorethamine, vincristine, procarbazine, and prednisone

Article Abstract:

Hodgkin's disease is much more commonly found in the upper torso than in the lower torso. Due to the relative paucity of information, it is difficult to reliably estimate survival rates for patients with lower torso disease; it is also difficult to evaluate the effectiveness of treatment without sufficient data for comparison. To review the treatment of Hodgkin's disease in the lower torso, the case histories of 60 patients, diagnosed between 1956 and 1987, were examined. All patients received radiotherapy; some received adjuvant chemotherapy consisting of mechlorethamine (also called Mustargen), vincristine, procarbazine, and prednisone (abbreviated the MOPP protocol). The overall 10-year survival rate for these patients was 90 percent. Among patients receiving only radiation, those with inguinal/femoral or pelvic disease fared better than those with abdominal lymphomas; the overall 10-year survival was 90 and 66 percent for patients with pelvic and abdominal disease, respectively. However, the addition of the MOPP to the radiotherapy of the patients with abdominal disease produced a striking improvement in the outcome. Of 14 patients with abdominal lymphomas treated with radiation and MOPP, 100 percent are alive and 92 percent are free from progression. (Consumer Summary produced by Reliance Medical Information, Inc.)

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