Geintourinary Malignancies in Children
ABSTRACT The modern management of pediatric genitourinary malignancies has resulted in survival rates that are dramatically better than figures from just a few decades ago. This is largely due to advances in multimodal treatment, collaborative efforts, and multidisciplinary management. Nevertheless, issues related to long-term side effects, treatment-related morbidity, and progression or recurrences remain important and pressing in terms of research directions and areas for improvement. In this Editorial Comment the author attempts to employ the current state of the art, masterfully summarized in the accompanying review by Drs Grimsby and Ritchey, to provide a view of trends that are likely to become increasingly important in the future, highlighting common patterns in treatment philosophy seen in other areas of oncology: more selective or patient-tailored treatment strategies, refined protocols and -whenever possible- tissue sparing and minimally invasive surgical interventions.
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ABSTRACT: We determine patient and tumor characteristics, event-free and overall survival, methods of local control, rate of bladder preservation and proportion with normal bladder function for patients with localized bladder/prostate (BP) rhabdomyosarcoma (RMS) treated on the Fourth Intergroup Rhabdomyosarcoma Study (IRS IV). We reviewed the records of 90 patients with nonmetastatic BP RMS enrolled on IRS IV for presenting characteristics, details of therapy and outcome. Of the 90 records 88 had sufficient information for review. Patient age distribution was less than 1 year for 7 patients, 1 to 9 years for 71 and 10 or greater years for 10. Tumors commonly arose in the bladder (70%), had favorable histology (embryonal or botryoid 80%), large (69% greater than 5 cm), unresectable (84% group III) and invasive (56% T2). Local therapy included radiation in 74 patients, and most patients underwent second-look operations after radiation. All patients received alkylating based chemotherapy. With a median followup of 6.1 years there have been 3 second malignancies, 1 toxic death and 18 relapses, for an event-free survival rate of 77%. Bladders were retained without relapse at last contact in 55 patients. Of those 55 patients 36 and of the entire group 40% had normal function determined by history. Of patients with nonmetastatic BP RMS on IRS IV 82% survived 6 years. Bladder function was preserved in 55% (36/66) of event-free survivors. Of all patients entered on study 40% (36 of 88) survive event-free with apparently normal functioning bladders. More precise long-term evaluation of bladder and sexual function will require application of better tools such as urodynamic studies and validated patient surveys.The Journal of Urology 07/2004; 171(6 Pt 1):2396-403. DOI:10.1097/01.ju.0000142659.78358.f9 · 3.75 Impact Factor
- European journal of cancer (Oxford, England: 1990) 09/2011; 47 Suppl 3:S230-8. DOI:10.1016/S0959-8049(11)70169-1 · 4.82 Impact Factor
- The feasibility and outcome of nephron-sparing surgery for children with bilateral Wilms tumor. The St Jude Children's Research Hospital experience: 1999-2006. 2008. Cancer 112 2060-70..