Cancer in Childhood by John R. Evans M.D., D.Phil. (Oxon.), F.A.C.P., F.R.C.P.(C)

By John R. Evans M.D., D.Phil. (Oxon.), F.A.C.P., F.R.C.P.(C) (auth.), John O. Godden M.D., C.M., M.Sc.(Med.), F.R.C.P.(C), M.A.(Educ. Th.) (eds.)

Viewed as contributions to carrying on with scientific schooling, many clinical conferences disappoint simply because, even if software committees plan with care, assemble first-class college and disclose them to their friends, to different physicians and to deal with employees. the impression is evanescent. conferences fritter away a lot specialist time and public cash to stimulate the quite few who attend. as a result the dictum "Hold a symposium and achieve a couple of hundred; move a complaints and succeed in the realm. " regardless of this dictum, many organizers of clinical conferences shrink back from the e-book of complaints. insisting that academics won't take part in the event that they need to organize publishable manuscripts and, in the event that they do conform to arrange them, will hold up for months or, every now and then, won't come via in any respect. despite the fact that, this is a question of association and backbone: e. g . . a few application chairmen make the cost of bills and honoraria contingent upon receipt of a publishable manuscript. Cox and his colleagues in Australia went one larger: they equipped the 1st foreign melanoma convention in Sydney in November 1972 and released a two-volume court cases ("Melanoma and pores and skin melanoma" and 'The Nature of Leukemia") sooner than the conferences all started. As Dr. Cox notes, "This preprinting of the complete papers freed every one speaker from the need of recounting huge amounts of knowledge in order that every one paper will be opened extra swiftly and provocatively after which defended in dialogue" (Report of the foreign melanoma convention, Med J an inventory, I: 12-33, June 24, 1972).

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Thus, metastases have been recognized and treated earlier than they were before 1957. Treatment of Pulmonary Metastases Before 1957, metastases to the lungs were often not treated. Only two patients had irradiation of the whole lung and five had a portion of the lung irradiated (Table VI). Since 1957, 28 children have had whole lung irradiation to a tumor dose of 2000 rads in four weeks. /day during the course 34 of radiation. Of the 22 patients treated with pulmonary irradiation and a course of actinomycin-D, 14 (64%) are alive with no evidence of disease four years after their diagnosis.

Could be that they had more extensive disease than those who did not receive it, although all patients were in Group I or II. Involvement of the renal vien or hilar nodes was more common in the patients who received actinomycin-D. Among eight such patients who received actinomycin-D, four developed distant metastases. In those children who did not receive actinomycin-D, two had node or vein involvement, and one got a distant metastasis. If patients who had involvement of the renal vein or lymph nodes are excluded from the two groups, there is still no difference in the incidence of recurrence of those who received actinomycin-D - nine of 29, and those who did not receive actinomycin-D - 11 of 33.

Janeway Child Health Centre, St. John's, Newfoundland. Y .. A. tThe Hospital for Sick Children, Toronto. :The Princess Margaret Hospital, Toronto. $The Princess Margaret Hospital, Toronto. 55 Dr. Darte: What about Group I patients? Dr. Sonley: At present we use local tumor-bed irradiation postoperatively combined with actinomycin-D. However, we should look at this program to see if we can decrease this combined treatment further or omit it altogether in some patients. Dr. Jenkin: It is important not to overtreat a child with Wilms' tumor.

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