Bulletin du cancer
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Review Comparative Study
Intensive chemotherapy with stem cell support-experience in pediatric solid tumours.
A recent Consensus Conference in Lyon reviewed the role of high-dose therapy with stem cell rescue in a variety of malignancies including childhood tumours. The conclusion was that with the exception of metastatic neuroblastoma there is still no proven role for this treatment strategy. It is more than 10 years since this approach was used in neuroblastoma and it has subsequently been applied to most of the common childhood solid tumours. ⋯ In this group of diseases which are inherently chemosensitive, the poor results from chemotherapy in the past have resulted from a failure to achieve appropriate drug levels at the tumour site and this may be potentially overcome by dose escalation. In Wilms' tumour, although the overall cure rate is very high, there appears to be a useful role for megatherapy in certain high-risk relapsed patients who have little chance of cure with conventional salvage therapy. There is an urgent need for international collaboration to design randomised studies which will as rapidly as possible address the issue of the role of these expensive and high morbidity procedures in childhood cancer.
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Arguments for the use of high-dose chemotherapy followed by autologous bone marrow transplantation in pediatric solid tumors are discussed. The dose effect relationship in pediatric oncology conventional chemotherapy is emphasized. Results of high-dose chemotherapy followed by autologous bone marrow transplantation are encouraging in metastatic neuroblastoma and Ewing's sarcoma. ⋯ This therapeutic approach could be of value in other pediatric solid tumors, particularly in some poor prognosis forms of Wilm's tumors. However, until now, the results remain preliminary. On the other hand, the role of this strategy in chemoresistant tumors, such as malignant gliomas, remains under investigation.