Melvin Tefft

Primary Ewing's sarcoma of the ribs: A report from the intergroup Ewing's sarcoma study

Thirty‐six patients with primary Ewings sarcoma of the ribs have been reviewed. Of these, 21 had clinically localized disease at diagnosis and were entered on protocol IESS 7299, eight had regional and seven metastatic disease at diagnosis and were entered on protocol 7450. The 21 with localized disease were treated with surgical excisio or biopsy, followed by local radiotherapy (in all but one patient) and randomization to one of three chemotherapy regimens. Eleven patients (52%) remain disease‐free for periods ranging from 18 to 64 months, respectively. Seven of eight patients who underwent complete surgical excisio of the primary lesion remain disease‐free after partial excision or biopsy. However, analysis of sixe of tumor at diagtnosis revelas thjat smaller primary tumors have a better prognosis irrespective of extent of surgery. Protocol IESS 7450, consisted of radiotherapy to all areas of known disease and four drug chemotherapy. Four (50%) with regional disease but none with metastatic disease have remained alive and continuously disease‐free. It is concluded that an aggressive approach to Ewings sarcoma of the ribs is justified by the results, as even regional disease may be curable. The apparent prognostic advantgage for those patients undergoing surgical excision may be explained by patient selection.

Radiation therapy of Wilms' tumor: results according to dose, field, post-operative timing and histology.

Abstract The results were reviewed after radiation therapy (RT) and systemic chemotherapy in 250 patients enrolled in the National Wilms Tumor Study (NWTS). Factors considered were delay in initiating post-operative RT, dose delivered, field sizes employed, and the histology tumor grade. Good local control was observed; only 5 patients had recurrent disease confined to the operative bed. Delays of up to nine days were not associated with adverse results. The field sizes employed, most often designed to include the tumor bed and the adjacent para-aortic lymph nodes, appeared to have provided adequate coverage. Relapse-free survival rates and rad doses in the range used were not correlated; doses greater than 2400 rad (1000 rad/week) did not yield better results. Lower doses, e.g. 1800–2000 rad appeared satisfactory in infants under 13 months of age. Histologic grade was a potent prognostic indicator. Patients with anaplastic tumors and those with sarcomatous features have high relapse and mortality rates. The NWTS already has shown that children under 2 years of age with localized tumors that are totally removed, and who receive systemic single agent chemotherapy, gain no advantage from post-operative RT. Two-year survival rates for these irradiated and non-irradiated children were 9796 and 9496 respectively. However, fewer infradiaphragmatic relapses and fewer deaths were recorded in their older irradiated counterparts when compared with those 2 years old or more not given RT. No such difference is apparent in 97 non-irradiated patients of all ages with early disease followed for at least 1 year in the second NWTS, all of whom were given double agent chemotherapy. These observations, together with the results of this review, which do not show a distinct correlation between RT parameters and outcome, call for re-examination of the role of post-operative irradiation in the modern management of Wilms tumor patients.

Postoperative radiation therapy for residual Wilms' tumor. Review of group III patients in the National Wilms' tumor study

Fifty‐eight patients with residual abdominal disease (Group III) are reviewed from National Wilms Tumor Study #1. The total number of abdominal recurrences is relatively low (eight cases). Local irradiation of the renal fossa would seem to be sufficient treatment for disease believed to be limited to that region, including cases of local spillage. Whole abdominal irradiation is recommended for gross, diffuse peritoneal contamination.

Patterns of intra-abdominal relapse (IAR) in patients with Wilms' tumor who received radiation: analysis by histopathology. A report of National Wilms' Tumor Studies 1 and 2 (NWTS-1 & 2).

Abstract 336 non-metastatic patients who received radiation in National Wilms Tumor Study-1 and 2 have been reviewed. Follow-up was minimum of two years. 15/273 (6%) of the favorable histology patients had intra-abdominal relapse as compared to 8 44 unfavorable histology (18%) (P = 0.003). Developing intra-abdominal relapse does not seem related to low radiation therapy doses or small volumes. However, a delay of greater than ten days to start radiation therapy from nephrectomy was related to the occurrence of intra-abdominal relapse in unfavorable histology patients (P