Primary testicular tumors in childrenThe cases of 37 children with testicular germ cell tumors attended at a metropolitan hospital of Santiago, Chile, between the years 1968 and 1984 are analized. The histologic types of their tumors were in 26 cases infantile embrional carcinoma (IEC), in 7 inmature teratoma and in 4 mature teratoma. The 26 IEC patients were treated with orchiectomy: 5/26 with orchiectomy alone, 5/26 with orchiectomy plus lymphadenectomy (negative histology) and 16/26 with orchiectomy plus chemoterapy using methotrexate, D actinomycin and cyclosphosphamide (MAC). 2/7 patients with inmature teratoma were treated with oichiectomy alone, 2/7 with orchiectomy plus lymphadenectomy and 3/7 with orchiectomy and chemotherapy (MAC). 4/4 cases of mature teratoma were treated with surgery. Four of the 33 patients with malign germ cell tumors died, all of them with IEC: two were in stage II and they were treated with orchiectomy alone; the other two, instage I, were managed by orchiectomy and lymphadenectomy, relapsed and died; 29/33 patients aie alive without evidence of disease after 1 to 16 years of follow up. Five IEC cases relapsed and 3 were treated with PVB (Cis-platinum, vinblastine and bleomicine) with good results. We think that malign germ cell tumors of the tesies at stage I can be treated with surgery alone and must be followed by alphafetoprotein levels and chest radiograph. If they relapse (15%) they can be treated and cured with chemotheraphy (PVB). (Key words: Testicular tumors, prognosis, treatment, alphafetoprotein}.Los tumores testiculares (TT) representan el 1 a 2% de los tumores solidos malignos 1 en la infancia y estan en el septimo lugar en orden de frecuencia. Su baja incidencia explica la razon por la que su tratamiento aun no este bien definido. La mayoria de estos tumores (75 a 80%) son de origen germinal 2 y entre estos predomina el carcinoma embrionario infantil (CEI) 'o carcinoma del saco vitelino. Su diseminacion se efectua especialmente por via hematogena 2 -3 ' 4 , a diferencia de los TT malignos del adulto que lo hacen por vi'a linfatica, por lo que se justifica un mayor uso de quimioterapia sistemica y uno menor de linfadenectomia retroperintoneal y radioterapia. Uno de los principales avances en los ultimos anos es el desarrollo de radioinmuno-analisis para los marcadores sericos: Alfafetoproteina (AFP) y gonadotrofina corionica humana (HGC.) que contribuyen al diagnostico, clasificacion y seguimiento de los tumores de celulas germinales 5 -6 .La mas utilizada es la AFP que esta ligada a la presencia del componente vitelino en el CEI.

Second malignant tumors in childrenStudies were made on the appearance of second malignant tumors (SMT) in children followed in a pediatric hospital at metropolitan Santiago, Chile, between years 1968 and1987. A retrospective analysis identified SMT in 7 of 430 patients who survived a childhood cancer (incidence 1.62%). An 8 tn patient was added, whose first neoplasm was treated in another hospital. The initial diagnosis in the afected children were meduloblastoma, neuroblastoma, Wilrn's tumor retinoblastoma, Ewing's sarcoma, Hodgkin's disease and, in two cases, acute lymphocytic leukemias. The age range was 6 months to 11 years. Treatment was done by surgery in 5/8, chemotherapy in 7/8 and radiotherapy in all patients. The latent period between the diagnosis of the first cancer and the diagnosis of the SMT was 3.5 to 12 years (median 8.5 years). Osteosarcomas were the most frecuent SMT (5/8). The other SMT were a rhabdomyosarcoma, a non Hodgkin lymphoma and an astrocytoma. The majority of SMT were located in the area of prior radiotherapy (6/8). In the other two cases, one had an osteosarcoma, after a bilateral retinoblastoma, which grew outside the previously treated area, and the last one consisted of a lymphoma which was identified 9 years after an acute lymphocytic leukemia. Only 3/8 SMT patients are alive after 14.21 and 34 months follow up. The other children died between 11 and 20 months after diagnosis of SMT. Notwithstanding these kinds of outcome, benefits of therapy for patients with primary tumors greatly outweight the later risk of cancer induction in a small proportion of them. (Key words: second cancer, radiotherapy, chemotherapy.) El pronostico de los pacientes con cancer infantil ha mejorado considerablemente en los ultimos arios. En la actualidad es posible la curacion de mas del 50% de ellos, debido fundamentalmente a los adelantos en los tratamientos de cirugfa, radioterapia y quimioterapia multiple 1 ' 7 .Sin embargo, estos tratamientos tienen complicaciones a corto plazo, por efectos toxicos sobre las celulas normales del organismo y, a largo plazo, por su potencial accion oncogenica 1 ' 3 ' ^ 9 .Los segundos canceres (SC) han aumentado debido a mayores sobrevidas y tiempos de seguimiento de los pacientes pediatricos oncologicos. Ademas, existe cierta predisposicion genetica a desarrollar mas de un cancer, lo que se ha hecho, tambien, mas manifiesto en las ultimas decadas, como resultado del tratamiento del primer cancer.El objetivo de este trabajo es describir los SC observados en nuestro servicio y sus relaciones con el tipo de cancer inicial y el tratamiento efectuado. 1. Servicio de Oncologia, Hospital Luis Calvo Mackenna. MATERIAL Y PACIENTESSe revise la estadistica del servicio de oncologi'a del Hospital Luis Calvo Mackenna desde 1968 a 1987. En este pen'odo fueron atendidos 1.580 pacientes, de los cuales 430 terminaron su tiatamiento sin mostrar evidencias de la enfermedad inicial hasta la fecha. En siete de ellos se presento un SC histologicamente diferente del primario. Se registra...