Treatment of Metastases in Nephroblastoma
AbstractFROM RADIUMHEMMET AND THE DEPARTMENT OF PEDIATRICS, KAROLINSKA SJUKHUSET, - s-104 01 STOCKHOLM, SWEDEN. TREATMENT OF METASTASES I N NEPHROBLASTOMA B. JEREB and L. AHSTROM The metastatic disease in nephroblastoma may consist of microscopic or macroscopic metastases, which influences the mode of treatment. For the treatment of microscopic metastases the term prophylactic chemotherapy is used in this report. The only means at present to treat microscopic metastases successfully is multidrug therapy as in other malignant tumors such as Ewingâs sarcoma (ROSENet coll. 1974), rhabdomyosarcoma (GHAVIMI coll. 1973), and as et indicated in nephroblastoma in the National Wilmsâ Tumor Study (State Center, Seattle, Washington; DâANGIO 1974). Single drug chemotherapy has not been successful in preventing metastases in nephroblastoma (JEREB & EKLUND 1973). Multidrug chemotherapy is, however, prolonged and not without harm to the patient. The question therefore arises of how to distinguish the patients with high risk for spread of disease from those with low risk, in whom prophylactic chemotherapy may not be necessary. In patients with macroscopic metastases, marked improvement in the treatment results has been achieved in recent years. This is considered to be due to more active and intensive treatment (SCHWEISGUTHSCHLINGER & 1967, VIETTIet coll. 1970).