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Between 1968 and 1985 35 patients with an histological proven medulloblastoma received radiotherapy after surgery. Patients are divided into three groups, showing the improvement in diagnostic procedures as well as in therapy. These changes result in a higher proportion of patients living longer without disease. Only a close cooperation between surgeon, radiotherapist and pediatric oncologist will give these patients the best chances of cure, if they are treated in multicenter studies.

We examined the frequency and kind of cancer in families with a child having a neoplasm at the Universitätskinderklinik Homburg/Saar, at the Universitätskinderklinik Freiburg and at the Institut für Medizinische Statistik und Dokumentation der Johannes Gutenberg-Universität Mainz. The following could be shown: 1. There is no difference in the distribution of various kinds of cancer in children, whether they have relatives with cancer or not. 2. It is necessary to examine the family history repeatedly to obtain an accurate documentation of familial cancer. 3. Cancer in familial members did occur in a third of all families on an average. 4. Independently of the diagnosis of the child, in most families only one additional family member did have cancer. 5. The majority of relatives with cancer are grandparents. 6. Cancer of the lung and of the breast are the most frequent kinds of neoplasms occurring in family members. 7. Comparing the most frequent kinds of neoplasms in family members in this study with the distribution of cancer in adults, it is obviously, that there is a higher percentage of leukemia and brain tumors in relatives of children with cancer than is expected. 8. Typical tumor constellations can be found in affected families like breast cancer and soft tissue sarcomas.

An intensive 7-day combination chemotherapy protocol was designed to reinduce children with early bone marrow relapse of acute lymphoblastic leukemia (less than 6 months after the end of or during preceding treatment). This aggressive approach seemed to be justified for a group of patients who were at the highest risk for ultimate treatment failure. In all, 38 children were enrolled for study. The ratio of male (median age, 10 years) to female (median age, 13 years) subjects was 27:11. Thirty patients were treated for their first relapse and eight for their second or subsequent relapse. Isolated bone marrow involvement was present in 24 cases. All patients had received heavy pretreatment including anthracyclines with cumulative doses of between 120 and 240 mg/m2. 22 of these patients, achieved complete remission, ten did not respond to therapy, and six died from the toxicity of the protocol. Cardiac failure was the cause of death in one child (after additional radiotherapy for a mediastinal mass). No further clinical manifestation of cardiomyopathy could be observed. The other five patients died from hemorrhages or infectious complications. The main side effects were fever, gastrointestinal problems, stomatitis, and severe bone marrow aplasia lasting for about 2 weeks with nadirs of platelets and white blood count around days 10-14. The remission rate of 60% was acceptable, though not satisfactory. Only four children survived disease-free for 13+, 14+, 20+, and 22+ months after diagnosis of relapse.