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In Memory

Smsunfl Ryan

Patient Information

Age: 12

Sex: Male

Diagnosed: 02/91

Relapsed: 12/31/93

Location:

Diagnosis: Pelvic primary, with omental and peritoneal metastases studding the large bowel. Diagnosed DSRCT by Juan Rosai (the pathologist who originally described this pathologic entity).

Hospital Children's Hospital of Philadelphia

Oncologist Dr. Arthur Ross

Hospital Albany Medical Center

Surgical Oncologist: Dr. Eugene Wiener

Children's Hospital of Pittsburgh

Passed Away: 12/17/95

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Treatment

Surgery

Inoperable. Small tumors and one massive tumor within abdomen.
Debulking - Removed a 7cm x 8cm x 9cm tumor from pelvic floor. Peeled it off the other organs in a five hour operation. Other much smaller tumors were also found sprinkled throughout abdomen.
Surgery #3 - Relapse. Large tumor had choked intestines by the ileum, where the large and small intestines join. Another, smaller tumor was found partially blocking the small intestine "upstream". An ileostomy was performed to eliminate the blockage. Once again, numerous small tumors were found throughout abdomen.
Surgery #4 -Removed ileostomy and restored to normal. Tumors were "sprinkled like salt" throughout abdomen and were inoperable.

Biopsy

Two small tumors growing behind his bladder

Radiation

During second surgery a Dektal mesh sling was inserted into abdomen to elevate the abdominal organs to allow the radiologist to "cone done" into the pelvic floor to deliver more direct radiation. The sling would descend by itself in six weeks.
Vincristine/5-FU along with seven weeks of irradiation.

Chemotherapy

Four cycles - Carboplatin, Cytoxin, and VP-16
MSKCC - P6 Protocol - Two rounds - Cytoxan/Adriamycin/Vincristine alternating with Ifos/VP.
MD Anderson Protocol - 3 cycles of Bleo/MTX/Cisplat/VCR alternating with Cytox/Actino/VCR. 1 cycle of ACE.
Taxol

Stem Cell Transplant

High dose chemo - Melphalan, carboplatin, and etoposide

Complication: During stem cell transplant, the triple lumen cathetar became infected with klebsiella pneumoniae and was in the superior vena cava. Surgery needed. Sepsis continued. On kidney dialysis.

Time Line

Date Test Treatment Chemicals Result
2/91 0 Surgery #1 0 Massive tumor in abdomen along with smaller tumors. Inoperable.
3/8/91 0 Surgery #2 0 Removed 7cm x 8cm x 9cm tumor from pelvic floor. Pealed it off other organs in a five hour operation. Other much smaller tumors were also found sprinkled throughout his abdomen.
4/91 0 Radiation Vincristine/5-FU along with seven weeks of irradiation. 0
5/91 0 Radiation Vincristine/5-FU along with seven weeks of irradiation. 0
6/91 0 Chemotherapy 1 Carboplatin, Cytoxin, and VP-16 0
7/91 0 Chemotherapy 2 Carboplatin, Cytoxin, and VP-16 0
8/91 0 Chemotherapy 3 Carboplatin, Cytoxin, and VP-16 0
9/91 0 Chemotherapy 4 Carboplatin, Cytoxin, and VP-16 0
10/91 CT 0 0 No evidence of disease
11/91 0 0 0 0
12/91 0 0 0 No evidence of disease
1/92 0 0 0 0
2/92 0 0 0 0
3/92 0 0 0 No evidence of disease
4/92 0 0 0 0
5/92 0 0 0 0
6/92 0 0 0 No evidence of disease
7/92 0 0 0 0
8/92 0 0 0 0
9/92 0 0 0 No evidence of disease
10/92 0 0 0 0
11/92 0 0 0 0
12/92 0 0 0 0
1/93 0 0 0 No evidence of disease
2/93 0 0 0 0
3/93 0 0 0 0
4/93 0 0 0 No evidence of disease
5/93 0 0 0 0
6/93 0 0 0 0
7/93 0 0 0 0
8/93 0 0 0 0
9/93 0 0 0 no evidence of disease
10/93 0 0 0 0
11/93 0 0 0 No evidence of disease
12/31/93 0 Surgery 0 Relapse. Large tumor choked intestines by the ileum, where the large and small intestines join. Smaller tumor blocking the small intestine "upstream". An ileostomy was performed to eliminate the blockage. Numerous small tumors were found throughout abdomen.
1/94 0 Chemotherapy - P6 Cytoxan/Adriamycin/ Vincristine 0
2/94 0 Chemotherapy - P6 Ifos/VP Became obstructed and changed protocol
3/94 0 Chemotherapy Bleo/MTX/Cisplat/VCR 0
4/94 0 Chemotherapy Bleo/MTX/Cisplat/VCR 0
5/94 0 0 Bleo/MTX/Cisplat/VCR 0
6/94 0 0 Cytox/Actino/VCR 0
7/04 0 0 0 0
8/94 0 Surgery #3 0 Removed ileostomy and restored to normal. Tumors were "sprinkled like salt" throughout abdomen and it was impossible to remove the small tumors.
9/94 0 0 0 0
10/94 0 0 0 0
11/94 0 Chemotherapy Taxol 0
12/94 0 0 0 0
1/95 0 0 0 0
2/95 0 0 0 0
3/95 0 0 0 0
4/95 0 0 0 0
5/95 0 0 0 0
6/95 0 0 0 0
7/95 0 0 0 0
8/95 0 0 0 0
9/4/95 Biopsy Total body irradiation - 2 weeks 0 Two small tumors growing behind bladder
10/95 0 Stem Cell high dose chemo Melphalan, carboplatin, and etoposide 0
10/19/95 0 Started Stem cell transplant 0 0
10/22/95 0 0 0 Coded with septic shock. klebsiella pneumoniae, was in his superior vena cava and traveling to heart.
11/95 0 0 0 Complications with bladder and kidneys. Kidney dialysis.
12/7/95 0 0 0 Passed Away

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