Prognosis and treatment after relapse of XXXX and @entity1893 : 1985. A report from the Childrens Cancer Study Group.

@entity1893 @entity1 @entity981 @entity5
@entity981 and @entity1893 constitute 42% to 45% of the @entity5 in @entity1 , @entity1 , and adolescents: In 1985, an estimated 2025 @entity1 were newly diagnosed with these two @entity5 and 900 (43%) of the @entity5 deaths in the United States have been projected to be due to these diseases. The single most important obstacle to preventing these deaths is relapse, and prevention of relapse or salvage of the @entity1 who has had a relapse continues to be a major therapeutic challenge. The most important initial step in the treatment of the @entity1 whose disease has relapsed is to determine, to the extent possible, the prognosis. In a @entity1 with @entity1893 , a relapse confers an extremely poor prognosis, regardless of site of relapse, @entity5 histology, or other original prognostic factors, prior therapy, or time to relapse. In the @entity1 with @entity981 in relapse, the prognosis depends on multiple factors. The primary therapy is chemotherapy or chemoradiotherapy with marrow grafting. Other options exist, including no therapy, or investigational therapy. The therapy selected should be predicated on the prognosis. In the @entity1 with an isolated central nervous system (CNS) relapse off therapy, minimum therapy should be administered, particularly if the relapse occurred without prior cranial irradiation. In the @entity1 whose relapse is more than 6 months off therapy, conventional therapy should be considered. Also, a @entity1 with an isolated CNS relapse on therapy after prior cranial irradiation should be given moderate therapy. Bone marrow transplantation or high-dose chemoradiotherapy with autologous marrow rescue should be reserved in @entity1 with a second or subsequent extramedullary relapse, and possibly for those with a first isolated overt testicular relapse on therapy.
