Staging problems in the pre-operative chemotherapy of XXXX .

@entity1 @entity66 @entity5 @entity1358 @entity3 @entity3969
OBJECTIVE: To determine the effect of the International Society of Paediatric Oncology (SIOP) @entity3969 protocols (pre-operative chemotherapy based on clinical and radiological findings, with no prior @entity5 verification by open or needle biopsy) on subsequent intra-operative @entity5 diagnosis and @entity5 . @entity1 AND METHODS: The diagnosis and @entity5 of possible @entity3969 by clinical, ultrasonographic and radiological assessment were compared with the intra-operative findings in 14 consecutive @entity1 (1-12 years of age) treated between 1989 and 1994. RESULTS: A diagnosis of @entity3969 was histologically verified in 11 of 14 @entity1 . In two @entity1 , verification was not possible due to @entity5 following pre-operative chemotherapy. In a 12-year-old @entity1 with an estimated stage @entity66 due to a solitary lung metastasis, a @entity1358 was revealed in the nephrectomy specimen while subsequent thoracotomy revealed dysmorphic but not malignant tissue. The estimated @entity5 stage was correct with regard to localized or metastatic disease in nine of 11 @entity1 with histologically confirmed @entity3969 , while in two @entity1 with an estimated @entity5 , liver @entity3 were found intra-operatively and the @entity5 was upstaged to IV. CONCLUSION: Exact @entity5 diagnosis and @entity5 was difficult in these @entity1 . Although the accuracy of @entity5 @entity5 depends on the sensitivity of radiological and ultrasonographic examinations, difficulties in @entity5 diagnosis may be overcome by biopsies of the primary @entity5 . The justification of upstaging a @entity5 to stage III, provoking a more intense post-operative treatment, should be proven by prospective randomized studies. The decision to perform a primary @entity5 biopsy would be facilitated if possible subsequent deterioration of outcome could be excluded.
