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| Year : 2001 | Volume
: 6
| Issue : 4 | Page : 119-124 |
How safe and effective is preoperative intratumoral chemotherapy in advanced Inoperable pediatric solid malignancies?
AV Apte, V Kumar, SP Sharma, NC Arya, AN Gangopadhyay, DK Gupta, SC. Gopal
Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi
Correspondence Address:
AV Apte
Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi
 Source of Support: None, Conflict of Interest: None  | Check |
ABSTRACT: Preoperative intravenous chemotherapy for advanced inoperable solid pediatric malignancies has considerable side effects. We have started using chemotherapy by direct intratumoral route which produces better local effects on the tumor and has significantly lower rates of adverse effects. During the past 2 years we have given intratumoral chemotherapy in 15 patients with various advanced pediatric solid malignancies, 8 patients had advanced Wilms' tumor, 4 patients had advanced abdominal neuroblastoma and 3 had rhabdomyosarcoma. The drugs used were the standard VAC regimen for pediatric solid tumors. Intratumoral chemotherapy was given by a fine 25 G spinal needle into the tumor site under ultrasound guidance. Injection hyaluronidase was mixed with the chemotherapeutic agent to enhance local spread of the drug. A record of all the symptoms and signs was maintained to assess the adverse effects of chemotherapy. Preoperative intratumoral chemotherapy produced marked reduction in tumor size in all types of solid tumors. Seven cases of Wilms' tumor were operated following intratumoral chemotherapy. Two cases of neuroblastoma and 2 of abdominal rhabdomyosarcoma were also successfully excised. The adverse effects observed with conventional intravenous chemotherapy were far less with intratumoral chemotherapy. Intratumoral chemotherapy produces a better local reduction on tumor size without causing much adhesions. The adverse effects have also been observed to be considerably less than intravenous chemotherapy.
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