Involvement of inferior vena cava (IVC) by tumor thrombus occurs in up to 10% of patients with nephroblastoma. Right atrial involvement by tumor thrombus is much less frequent. Four patients presenting with advanced nephroblastoma were diagnosed as having IVC involvement with tumor thrombus. Two of these patients had in addition thrombus extending up to the right atrium. All 4 patients were treated with preoperative chemotherapy (vincristine, actinomycin D, 4-epi-Adriamycin). Nephrectomy was subsequently performed without undue difficulty on all 4 patients. The intravascular tumor thrombus had completely cleared in all 4 patients and most of the primary renal tumor was necrotic. The results obtained with preoperative chemotherapy as given to these patients mediates strongly against difficult surgery being undertaken as primary treatment for such patients.
Sarcomas of the head and neck are rare tumours accounting for less than 1% of all malignant neoplasms in this region. The prognosis of these tumours and the survival in adults (< 50% at 5 years) is directly related to histological tumour type, tumour size and the possibility of adequate tumour resection. In the present paper, the authors present the course of sarcomas with special reference to rhabdomyosarcoma and osteosarcoma in the nose and paranasal sinuses. Surgical resection with pathologically free margins represents the best modality of initial therapy. Additional adjuvant radiotherapy and/or chemotherapy have shown better survival rates in pediatric patients and, to some degree, also in adults. The purpose of future studies should be the development of new therapy protocols which could further elucidate the beneficial effects of adjuvant therapy in the treatment of sarcomas of the head and neck.
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