In 1970, a staging based on surgical resectability of hepatic tumors was devised. Adjuvant chemotherapy with vincristine, 5-fluorouracil, and cyclophosphamide has been given to seven recent cases. Objectives of this study were to set up unified clinical staging and followup; to evaluate the effect of combination chemotherapy on survival in advanced disease; and to evaluate early adjunctive combination chemotherapy in surgically resectable lesions to, hopefully, prevent metastasis. Results to date in seven patients are: no change in the poor prognosis of the three female patients presenting with Stage III-IV hepatocellular carcinoma; the three males with Stage I-II hepatoblastoma have done well and survive the free of disease at 47 months, 44 months, and 28 months; one patient with hepatoblastoma had lung metastasis at diagnosis and died at 7 months with tumor. No toxicity was noted with the use of adjunctive combination chemotherapy following major hepatic resection.

Until alternate diagnostic methods are discovered, the staging procedure seems to be the most reliable method to establish the presence or absence of abdominal involvement in Hodgkin's disease. Our experience with staging laparotomy in 22 children raises serious questions as to both the risk of operation and the prognostic value of a negative abdominal exploration. Routine use of the staging laparotomy may not be justified in clinical Stage IA patients with lymphocyte-predominant cell type. Because of the hazards and limitations of the staging procedure, vigorous attempts would seem to be indicated to identify subcategories of patients in whom the likelihood of intraabdominal involvement is so small as to negate the value of surgical staging.

Nineteen children with biopsy-proven rhabdomyosarcoma were selected for a 1-2-year study utilizing surgery, supervoltage, and electron-beam radiation therapy, and combination chemotherapy with vincristine, cyclophosphamide, and dactinomycin. At the time of diagnosis, 4 patients had localized tumor, 9 had regional spread of tumor, 5 had extensive spread of tumor, and 1 had bone marrow involvement. Complete response to therapy was seen in 17 patients, 2 had partial response followed by progressive disease, and 4 died with disease at 15, 11, 8, and 6 months respectively. Eleven patients were free of disease for 4-49 months; 2 had extension of disease at 2 and 4 months. Two patients were just entered on the study and response data is being investigated currently. This approach of extended combination therapy of childhood rhabdomyosarcoma was well tolerated and offers an alternative to radical surgery in the growing child.