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Combined Radiotherapy and Chemotherapy 1

The meeting was opened by Dr Dorothy Pearson (Christie Hospital, Manchester) who spoke on 'Management of metastatic malignancy can adult oncology learn from the paediatric field?' She considered several paediatric solid tumours in which the addition of chemotherapy to radiotherapy and surgery had improved relapsefree intervals and survival. A clear increase in survival could be seen in cases of nephroblastoma treated in Manchester from 1944 to 1974 as actinomycin D (and later vincristine and adriamycin) became available. She stressed that useful single-agent activity in solid tumours, together with optimal dosage and timing, should be established before a particular drug is incorporated in a multi-agent regime. The differences between American and European work in the evaluation of vincristine in nephroblastoma could be explained by variations in scheduling. In the treatment of rhabdomyosarcoma with combination chemotherapy including cyclophosphamide, the single-agent activity of the latter is unproven and it may prejudice the effect of the more active drugs by limiting their dose and by enhancing normal tissue effects. She then discussed the sequencing of combined modality treatment and indicated that starting chemotherapy before irradiation allowed local disease to regress and distant spread to be treated earlier. In addition, the drug response could be adequately assessed. She emphasized the need for long-term follow up of patients, especially in conditions such as Ewing's tumour where late recurrences and second malignancies may occur. The second part of the meeting was introduced by Dr Pearson who illustrated her remarks with survival figures from the Children's Tumour Registry in Manchester. Although combined treatment had provided encouraging results in many tumours, progress in some areas particularly brain tumours had been slower. Dr Ruth Sandland (St Bartholomew's Hospital, London) then talked of 'The advantages of combined radiotherapy and chemotherapy in childhood cancer' and pointed out that, before the days of effective chemotherapy, local control was attempted with surgery with or without radiotherapy. The former was frequently mutilating, whilst kilovoltage irradiation produced poor cosmetic and functional results. Combinations of