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The outlook for patients with germ cell tumors was poor before the advent of effective chemotherapy. In this study the outcome of multiagent chemotherapy in children treated for germ cell tumor is assessed. Between January 1984 and December 1990, 107 patients were diagnosed to have germ cell tumors. Postsurgical therapy was based on tumor site, stage, and histology. Combination chemotherapy was employed in patients with Stages I and II disease with postoperative raised tumor markers and all patients with Stages III and IV. Between 1984-1988, patients received cisplatin, vinblastin, bleomycin, and methotrexate (PVB-M), and thereafter between 1988-1990, they received bleomycin, etoposide, and cisplatin (BEP). Of 34 patients treated with PVB-M and 27 treated with BEP, the complete remission rate was 40% and 85%, respectively, and the overall survival was 30% at 5 years for PVB-M and 80% at 3 years for BEP. We conclude that etoposide with cisplatin is superior to vinblastin with cisplatin in the treatment of advanced germ cell tumors because of greater efficacy, decreased toxicity, and better compliance in children.

Twenty-nine patients with high-grade nonmetastatic osteogenic sarcoma of the extremities were treated with adjuvant chemotherapy following definitive surgery. Chemotherapy consisted of systemic intravenous Adriamycin and cisplatin in a sequential fashion given for six courses. Nineteen out of 29 patients are alive and continuously disease free over a follow-up period ranging from 9+ to 30+ months. The relapse-free survival was 72%, and overall survival for the entire group was 69%. Median survival is not reached yet. Six out of 29 patients relapsed, of which 1 patient is alive for 6+ months after relapse. Three patients died of chemotherapy toxicity. The results were superior to historical controls treated with surgery alone. The need for more aggressive treatment approaches is discussed.

Fifteen cases of histologically proven Askin Rosai tumor were treated at Tata Memorial Hospital over a period of 3 years. Patients included 12 men and three women. Clinical features included chest wall mass (14), pain (11), bony involvement (6), fever (4), dyspnoea (4), weight loss (1), cough (1), and hemoptysis (1). Previously treated patients received different treatment protocols, which made evaluation difficult. Of our ten patients who have completed induction therapy, five received vincristine and cyclophosphamide, whereas the other five received more aggressive chemotherapy. Complete remission has been achieved in two and four of these patients, respectively. One patient in each group had recurrence of the disease, in both cases at the local site. Thus, from our preliminary data, we suggest that Askin Rosai tumor should be treated with complete surgical excision followed by an aggressive combination of chemotherapy and local radiotherapy.

Nearly 50% of head and neck cancers and two-thirds of patients with esophageal cancer generally present late for initial treatment. The patterns of failure are generally locoregional with around 10% showing distant dissemination. Surgery alone and in combination with pre-operative radiation has not significantly increased salvage in these groups of cancer. The availability of increasingly effective drugs (Cisplatinum, MTX., Bleomycin), for head, neck and esophageal cancers have produced dramatic initial responses with excellent palliative relief of symptoms enabling adequate definitive radiotherapy or surgery for advanced T3, T4 lesions. Cisplatinum 20 mg/m2 daily X 5 - twice at the interval of 10 days with MTX 25 mg/m2 and Bleomycin 15 mg/m2 weekly X 2 have been used for T3 and T4 Head and Neck Cancers and Cisplatinum in the same dosage and MTX 200 mg twice in 10 days have been used for esophageal cancers. 88% responses in 35 patients have been noted in head and neck cancers and when the chemotherapy was followed by definitive radiotherapy, complete responses were achieved in 16 out of 25 patients (64%). This is a very significant response rate for T3, T4 cancers. Patients who were in a reasonably acceptable general condition after this regimen were further considered for two more courses of consolidative chemotherapy. Response rates in esophageal cancer was 78% (26 of 34 evaluable patients) - 6 of the 26 showed a complete response and all are alive from 8 months to 26 months. Our failure to obtain increasing cures at 3 and 5 years may be due to our ignorance of the capacity of dormant cells to proliferate, tumor cell kinetics, more effective use of chemotherapy or the biology of the host. These areas need further investigation.

Twenty-eight patients with pure or predominantly endodermal sinus tumor were studied for their clinical behavior, relation with serum alpha-fetoprotein (AFP), and response to intensive postoperative combination chemotherapy. Eight percent of the patients were younger than 20 years of age. One patient was a pseudohermaphrodite. Serum AFP was estimated in 17 patients and was elevated in all. Seven patients were treated with adjuvant chemotherapy following surgery with a cisplatin-containing combination. Five patients (71%) are alive and continue to remain free of disease, with a median survival of 28 months after treatment and an overall median survival of 34 months. Two patients treated with adjuvant chemotherapy experienced early recurrence of the disease, which was detected with a rise in serum AFP before the clinical manifestation of recurrence.