4th Course Research Articles

Antibody-dependent cellular cytotoxicity (ADCC) in COG ANBL0032: A phase III randomized trial of chimeric anti-GD2 and GM-CSF/IL2 in high risk neuroblastoma following myeloablative therapy and autologous stem cell transplant (ASCT)

2582 Background: ADCC plays an important role in the efficacy of anti-cancer monoclonal antibody therapy. We monitored ADCC activities of neuroblastoma patients enrolled on COG ANBL0032. Methods: High risk neuroblastoma patients who achieved a complete or very good partial response after induction therapy, myeloablation with carboplatin + etoposide + melphalan, ASCT, and local radiation according to COGA3973, were eligible for this study. After engraftment, they were randomized to 13-cis-retinoic acid (RA) x 6 courses or RA + immunotherapy with 5 courses of Ch14.18 and alternating cycles of GM-csf and IL2. Results: So far, 27 patients have been evaluated before treatment on day 76 ± 9 (62∼93) post-ASCT. The mononuclear cells of all 27 patients displayed ADCC which averaged 43.2 ± 28.3 LU20 (11.7∼138). Granulocytes of all 23 patients evaluated pre-treatment also showed ADCC with an average of 18.7 ± 17.9 LU20(3.4∼67.5). ADCC of both cell types were significantly less than that observed for 5 normal donors who had a mean of 145.7 ± 58.3 LU20 (P=0.001) for mononuclear cells and 26.7 ± 7.1 (P=0.0168) for granulocytes. ADCC mediated by both cell types in patients did not change significantly subsequently: before 4th course of RA/ immunotherapy on day 163, and before last course of RA/ immunotherapy on day 196. Although impaired chemotaxis of granulocytes has been reported during IL-2 therapy, we found no significant changes in granulocyte mediated ADCC, right before and after ch14.18 + IL2. Conclusions: These findings suggest that ADCC mediated by mononuclear cells and granulocytes are present shortly after ASCT and persist throughout the course of immunotherapy, albeit at lower levels than normal controls, which is consistent with the reported decreased ADCC in cancer patients. The preliminary findings so far indicated that there is residual ADCC following ASCT, which may allow the monoclonal antibody to be efficacious. No significant financial relationships to disclose.

Antibody-dependent cellular cytotoxicity (ADCC) in COG ANBL0032: A phase III randomized trial of chimeric anti-GD2 and GM-CSF/IL2 in high risk neuroblastoma following myeloablative therapy and autologous stem cell transplant (ASCT)

2582 Background: ADCC plays an important role in the efficacy of anti-cancer monoclonal antibody therapy. We monitored ADCC activities of neuroblastoma patients enrolled on COG ANBL0032. Methods: High risk neuroblastoma patients who achieved a complete or very good partial response after induction therapy, myeloablation with carboplatin + etoposide + melphalan, ASCT, and local radiation according to COGA3973, were eligible for this study. After engraftment, they were randomized to 13-cis-retinoic acid (RA) x 6 courses or RA + immunotherapy with 5 courses of Ch14.18 and alternating cycles of GM-csf and IL2. Results: So far, 27 patients have been evaluated before treatment on day 76 ± 9 (62∼93) post-ASCT. The mononuclear cells of all 27 patients displayed ADCC which averaged 43.2 ± 28.3 LU20 (11.7∼138). Granulocytes of all 23 patients evaluated pre-treatment also showed ADCC with an average of 18.7 ± 17.9 LU20(3.4∼67.5). ADCC of both cell types were significantly less than that observed for 5 normal donors who had a mean of 145.7 ± 58.3 LU20 (P=0.001) for mononuclear cells and 26.7 ± 7.1 (P=0.0168) for granulocytes. ADCC mediated by both cell types in patients did not change significantly subsequently: before 4th course of RA/ immunotherapy on day 163, and before last course of RA/ immunotherapy on day 196. Although impaired chemotaxis of granulocytes has been reported during IL-2 therapy, we found no significant changes in granulocyte mediated ADCC, right before and after ch14.18 + IL2. Conclusions: These findings suggest that ADCC mediated by mononuclear cells and granulocytes are present shortly after ASCT and persist throughout the course of immunotherapy, albeit at lower levels than normal controls, which is consistent with the reported decreased ADCC in cancer patients. The preliminary findings so far indicated that there is residual ADCC following ASCT, which may allow the monoclonal antibody to be efficacious. No significant financial relationships to disclose.

A Course in Spiritual Dimensions of Counseling: Continuing the Discussion

The author adds to the limited literature on counselor education courses that are based on the spiritual aspects of counseling by identifying the need for such course work, comparing and contrasting 3 previously published articles on such courses, and introducing a 4th such course in detail. Novel aspects of this newly introduced course and student assessment of various course activities and assignments are highlighted. The article concludes with questions that suggest future research directions.

중학생들을 위한 얇은막 크로마토그래피 실험 키트의 개발

제7차 교육과정의 가장 큰 특징은 수준별 교육과정의 시행이라고 할 수 있으며, 이에 따라 학생의 능력과 개인차에 따른 다양한 학습 과제의 개발이 필요하다. 제6차 교육과정의 중학교 과정에서 다루었던 크로마토그래피의 이론과 실험의 오류를 바로잡기위하여 중학생들이 크로마토그래피의 원리를 보다 정확하게 이해할 수 있는 새로운 실험 키트가 필요하다. 본 연구에서는 시중에 판매되고 있는 TLC판을 정지상으로 이용하고, 이동상으로는 상대적으로 인체에 해가 적은 혼합 유기용매를 사용하며, 시료 및 참고물질로는 시료의 전개 과정을 눈으로 쉽게 확인할 수 있는 산-염기 지시약들을 사용하여 새로운 크로마토그래피 실험 키트를 개발하였다. 또한, 이 실험 키트의 효과를 알아보기 위하여 중학생(일반 중학생 및 영재반 중학생)과 교사(과학 교사 및 비과학 교사)를 상대로 실험을 실시하여, 실험내용과 그 효과에 관한 설문을 조사하였다. One of the most important characteristics in the seventh educational course is an enforcement of differentiated level curriculum. Therefore, development of various different level educational subjects is needed. A new chromatographic experimental kit which is helpful for middle school students to understand chromatographic principles is needed to correct some mistakes of chromatographic part within the 6th educational course's middle school textbook. In this research, a new thin layer chromatography(TLC) experimental kit for middle school students are developed by using acid-base indicator as samples and ethyl alcohol, ethylacetate, hexane as eluents. The kit is applied to two kinds of middle school student groups(general group & genius group) and two kinds of teacher groups(science teacher & non-science teacher) and an efficacy of the new chromatographic kits are evaluated through making up some questions.

6th Course on Ear and Temporal Bone Surgery

6th Course on Ear and Temporal Bone Surgery

6th Course on Ear and Temporal Bone Surgery

6th Course on Ear and Temporal Bone Surgery

Preface

The 26th Annual Meeting of the Japanese Society of Sleep Research (JSSR) was held on the 28th and 29th June 2001 in Tokyo at the convention facilities of Hotel Nikko Tokyo, which was a fitting location and size to accommodate the 500 participants. The main concept of the Meeting was ‘Sleep and The Twenty-Four-Hour-Society’. The meeting consisted of the special guest lecture, the two symposiums, two workshops, the award-winner’s lecture, and 44 oral and 94 poster presentations. In addition, four luncheon seminars and two morning seminars were held. The special guest lecture was delivered by Dr Sato Honma from Hokkaido University, Japan, entitled ‘Sleep and biological rhythm’. Her stimulating lecture left a great impression on the audience. The invitation lecture was delivered by Dr Martin Moore-Ede from Circadian Technologies, Inc., entitled ‘Human circadian alertness technology in round-the-clock business’. He gave a stimulating and feasible lecture. The encouragement prize of JSSR in 2001 was given to Dr Mayumi Kimura from Division of Biocybernetics, Institute for and Dental Engineering, Tokyo Medical and Dental University, who presented the award-winning lecture entitled, ‘Granulocyte– macrophage colony-stimulating factor modulates rapid eye movement (REM) sleep and non-REM sleep in rats’. There were two symposiums. The first, ‘Disturbances of sleep rhythm on adolescences’ was chaired by Dr T. Ota and Dr K. Fukuda. Five attendees presented the most advanced and fruitful results of their studies. The second symposium, ‘Sleep disturbance of the twenty-four-hour society’ was chaired by Dr K. Honma and Dr M. Okawa. Six presenters discussed the most advanced and exciting results of their studies. With regard to the workshop, two themes were chosen. One was ‘Treatment of sleep-related breathing disorders—from children to the elderly’, which was chaired by Dr T. Shiomi and S. Miyazaki. Six speakers gave active and excellent presentations. The other appealing workshop was Advanced diagnosis and treatment of parasominia’, which was chaired by Dr T. Nozawa and Dr J. Kouyama. With sponsorship from the ISSR Educational Committee, the 6th Educational Course of Seminar of Sleep Science and Sleep Medicine was held on 30 July 2001 at The Jikei University Hospital, Shinbashi, Tokyo. This seminar was organized by Dr M. Ozone and five lecturers presented basic and advanced knowledge of sleep to young doctors, nurses, and technicians. The title of the 6th Seminar was ‘Disturbances of sleep–wake rhythm and its countermeasures’. Sixty-four participants received the sleep educational training, which included polysomnogaraphic techniques. The selected short original papers that were presented at the 26th Annual Meeting are published in this special issue of Psychiatry and Clinical Neurosciences as the official issue of the JSSR. The JSSR Academic Publishing Committee accepted manuscripts of no longer than two printed pages after a strict reviewing process. Presentations other than the oral and poster sessions (i.e. the special guest lecture, award-winner’s lecture, the symposiums, and the workshop lectures) are not included in this issue. For further information, the program and abstracts of the 26th Annual Meeting of the JSSR are available on the official website of JSSR (http://www.ashitec.ac.jp/jhome/jssr/index.html). In closing, we hope that this issue will stimulate much debate among researchers and that our Society will continue to grow well.

West Meets Easts: Breaking Barriers to Prevention in Asia and America

Rarely has this Chinese proverb elicited as enthusiastic a response as it did at the Preventive Cardiology Conference and 4th Certification Course in Cardiac Rehabilitation held in Hong Kong, February 17-20, 2001 (Figure 1). The meeting provided a unique opportunity for local and international experts to exchange information and gain insights into barriers to cardiovascular disease (CVD) prevention, and to discuss strategies to keep the growing global epidemic of CVD at bay.

Hypersensitivity Reactions to Carboplatin Administration Are Common but Not Always Severe: A 10-Year Experience

We have retrospectively evaluated and characterized the hypersensitivity reactions associated with carboplatin administration in ovarian cancer patients treated mainly on an outpatient basis at the Laikon Hospital from 1988 to 1998. A total of 240 patients, who had never been exposed to platinum compounds previously, received carboplatin plus cyclophosphamide (n = 58) or paclitaxel (n = 136) intravenously, and intraperitoneal carboplatin plus intravenous cyclophosphamide (n = 46). The median number of carboplatin courses was 6 (range 3–12) and 5 (range 4–6) for the intravenous and intraperitoneal treatment regimens, respectively. Thirty-two of 194 patients (16%) who were on intravenous carboplatin treatment developed symptoms compatible with a hypersensitivity reaction to carboplatin, that was always verified by manifestation of at least similar symptoms on rechallenging. In contrast, in the group of 46 patients on intraperitoneal carboplatin treatment, no hypersensitivity reaction was ever noticed. Hypersensitivity reactions always occurred after administration of the first 4 intravenous courses of carboplatin; 4, 19, 4, and 5 reactions occurred at the 5th, 6th, 7th, and 8th courses, respectively. These reactions could be distinguished in: (a) mild hypersensitivity reactions in 20 of 194 patients, which manifested as itching (20 patients) and small area erythema plus erythema of the palms and soles (12 patients), occurring either during intravenous injection when most of the drug scheduled had been administered, or within 3 days, and (b) in severe reactions in 12 of 194 patients, which manifested acutely as itching, diffuse erythroderma, rigor, facial swelling, throat and chest tightness, tachycardia (12 patients) and bronchospasm (2 patients), and hypertension or hypotension in 8 and 4 patients, respectively. With appropriate symptomatic management, discontinuation of carboplatin treatment was not required in patients with mild hypersensitivity reactions, but none of the 12 patients with severe reactions was able to receive a full subsequent dose of carboplatin on rechallenging. However, in 4 of these 12 patients carboplatin was replaced by cisplatin, which was given for 4–6 courses without side effects. These findings indicate that although hypersensitivity reactions are common in general, occurring in almost 1 of every 6 patients treated intravenously with carboplatin, their clinical picture is variable, leading to discontinuation of treatment in only 6% of patients. This is not the case when the intraperitoneal route of carboplatin administration is used when indicated.

4th AVA practice management course

Australian Veterinary JournalVolume 79, Issue 5 p. 304-304 Free Access 4th AVA practice management course First published: 09 October 2008 https://doi.org/10.1111/j.1751-0813.2001.tb11996.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume79, Issue5May 2001Pages 304-304 RelatedInformation

Preface

The 24th Annual Meeting of the Japanese Society of Sleep Research (JSSR) was held on 12 and 13 June 1999 in Hiroshima, Japan. This meeting consisted of the special guest lecture, the award-winner’s lecture, two symposiums, two workshops, 79 posters and 48 oral presentations. Thanks to every leading speaker of each topic and discussion, we believe this meeting was stimulating and fruitful for all the participants. We make specific mention of the remark of Professor RD Ogilvie from Brock University, Canada, in his special guest lecture entitled Psychophysiology of the sleep onset period. He stressed the importance of future research on psychophysiological aspects of the awake–sleep transition period and put forward the convergent analysis among behavioral, electrophysiological and psychological indices. It was exciting to learn of the psychophysiological experiments of the sleep onset period. Increasing studies of sleep onset have allowed clinicians and researchers in the emerging field of sleep disorders medicine to know that disordered sleep is commonplace, and that sleep disorders nearly always involve complaints of being unable to sleep or being unable to avoid going to sleep. There is growing recognition that psychological functioning is impaired by loss of sleep; the strong relationship between sleepiness and traffic accidents, reduced productivity and increased risk of accidents in the workplace, and lowered quality of daily life have intensified the need for greater understanding of the sleep onset period. We would say that the vigilance task method to evaluate the behavioral arousal as well as the convergent analysis of normal and abnormal processes would play an important role in the future study of sleep. The encouragement prize of JSSR in 1999 which was given to Dr. Y. Koyama at Fukushima Medical College, who presented the award-winning lecture entitled ‘In vivo electrophysiological distinction of histochemically identified cholinergic neurons using extracellular recording and labeling in rat laterodorsal tegmental nucleus’. There were two symposiums entitled ‘Good sleep and good waking’ chaired by Dr. M. Yamamoto and Dr. H. Fukuda, and ‘Pathophysiology and clinical approaches of restless legs syndrome’ chaired by Dr. T. Nozawa and Dr. J. Horiguchi. Two workshops were also held on ‘Sleep apnea in infant’ chaired by Dr. S. Miyazaki and Dr. T. Hashimoto and ‘Application of computers to sleep sciences of today and future’ chaired by Dr. Y. Sugita and Dr. S. Shirakawa. The topics presented in symposiums and workshops were not only of interest to sleep sciences researchers but also are the most exciting clinical development for the last decade. With the sponsorship of the JSSR Educational Committee, the 4th Educational Course of ‘Seminar of Sleep Sciences and Sleep Medicine’ was held in Hiroshima on 11 June 1999. This seminar was organized by Dr. J. Horiguchi to provide the basic and advanced knowledge in the domains of normal sleep and sleep disorders. The participants received five comprehensive lectures and intensive hands-on training of polysomnographic techniques. The selected short original papers presented at the 24th Annual Meeting are published in this special issue of Psychiatry and Clinical Neurosciences as the official issue of the JSSR. The JSSR Academic Publishing Committee accepted manuscripts in the size of two printed pages after a strict reviewing process. Presentations other than oral and poster sessions (i.e. the special guest lecture, the award-winner’s lecture, the symposiums, the workshops and the educational courses) are not included in this issue. For further information, the program and abstracts of the 24th Annual Meeting of the JSSR are available on our official web site of JSSR ( http://www.ashitech.ac.jp/jhome/jssr/gakujutu/1999/sub_index99.html). In closing, we hope that this issue will stimulate much debate among researchers and that our society continues to grow and prosper. GUEST EDITORS Judges Masako Okawa, (Guest Editor-in-Chief) National Institute of Mental Health, NCNP, Ichikawa Yutaka Honda, Neuropsychiatric Research Institute, Tokyo Shojiro Inoué, Tokyo Medical and Dental University, Tokyo Yasuro Takahashi, Neuropsychiatric Research Institute, Tokyo Referees Kazuhiko Fukuda, Fukushima University, Fukushima Ken-ichi Honma, Hokkaido University, Sapporo Tadao Hori, Hiroshima University, Hiroshima Toshinori Kobayashi, Ashikaga Institute of Technology, Ashikaga Tohru Kodama, Tokyo Metropolitan Institute for Neuroscience, Tokyo Yoshimasa Koyama, Fukushima Medical University, Fukushima Hitoshi Matsumura, Osaka Medical College, Osaka Mitsuyuki Nakao, Tohoku University, Sendai Tatsuro Ohta, Nagoya University, Nagoya Masaya Segawa, Segawa Neurological Clinic for Children, Tokyo Tetsuo Shimizu, Akita University, Akita Toshiaki Shiomi, Aichi Medical University, Aichi Zenji Shiozawa, Yamanashi Medical College, Yamanashi Makoto Uchiyama, National Institute of Mental Health, NCNP, Ichikawa Naoto Yamada, Shiga University of Medical Science, Shiga

Intravenous immunoglobulin treatment of lupus nephritis

Objective: To evaluate the clinical response of treatment-resistant membranousand membranoproliferative lupus nephritis to intravenous immunoglobulin (IVIg). Methods: Seven lupus nephritis patients who failed to respond to at leastprednisone and cyclophosphamide were studied. A kidney biopsy showing either membranous or membranoproliferative glomerulonephritis was available in six patients. They were treated with six courses (patients 1 and 2) or 1 or 2 courses (patients 3 through 7) of high-dose IVIg. For patients 3 through 7, the plasma levels of albumin, total cholesterol, urea, creatinine; dsDNA antibody titers, and daily proteinuria were measured just before the IVIg therapy, immediately on completion, and 6 months later. Results: All seven patients had a beneficial response to IVIg. In patient 1, decrease in proteinuria was evident 2 weeks after IVIg was started, nephrotic syndrome gradually disappeared, and she had no proteinuria in 3 years' follow-up. Decline in proteinuria was evident in patient 2 after the 4th IVIg course, but proteinuria reached the pretreatment level 4 months after the therapy ended. In patients 3 through 7, the mean daily proteinuria before IVIg (5.3 ± 2.1 g) decreased after 1 or 2 IVIg courses (3.3 ± 1.4 g), and further decreased when measured 6 months later (2.1 ± 1.3 g). Similarly, the plasma, cholesterol level decreased while the plasma albumin level increased after IVIg. Conclusions: IVIg might be effective in treatment-resistant membranous ormembranoproliferative lupus nephritis. Future studies should concentrate on determining the preferred treatment protocol of IVIg for the various classes of lupus nephritis.

第6回継続教育コース・医学図書館研究会報告

第6回継続教育コース・医学図書館研究会報告

6th European Training Course on Carbohydrates, 8–14 July 2000, Debrecen, Hungary

6th European Training Course on Carbohydrates, 8–14 July 2000, Debrecen, Hungary

O. Pecere and M. D. Reeve (eds), Formative Stages of Classical Traditions: Latin Texts from Antiquity to the Renaissance. Proceedings of a Conference Held at Erice, 16–22 October 1993, as a 6th Course of International School for the Study of Written Records (Biblioteca del ‘Centro per il collegamento degli Studi Medievali e Umanistici in Umbria’, 15). Spoleto: Centro Italiano di

O. Pecere and M. D. Reeve (eds), Formative Stages of Classical Traditions: Latin Texts from Antiquity to the Renaissance. Proceedings of a Conference Held at Erice, 16–22 October 1993, as a 6th Course of International School for the Study of Written Records (Biblioteca del ‘Centro per il collegamento degli Studi Medievali e Umanistici in Umbria’, 15). Spoleto: Centro Italiano di

The Effect of Very-low-dose Warfarin on Markers of Hypercoagulation in Metastatic Breast Cancer: Results from a Randomized Trial

Malignancy is a risk factor for thromboembolism and anti-cancer chemotherapy can increase this risk. Prophylaxis of thrombosis with very-low-dose warfarin given concurrently with chemotherapy has a significantly reduced rate of thromboembolism in a randomized trial in women with stage IV breast cancer. In a group of 32 patients randomized in one center (16 subjects on warfarin and 16 on placebo), we have prospectively studied the plasma levels of: 1. Markers of 'in vivo' clotting activation (thrombin-antithrombin complex [TAT], prothrombin fragment 1+2 [F1+2] and D-dimer), 2. Factor VII (FVII), and 3. Natural anticoagulants (protein C [PC] and antithrombin [AT]). The aims of this study were: 1. to examine whether laboratory tests predicted those patients who developed thrombosis, and 2. to evaluate the effect of very-low-dose warfarin on hemostatic variables. The patients' hemostatic parameters were evaluated before entry into the study and after starting chemotherapy +/- prophylaxis, before each course for nine courses. Before-treatment results were compared to those of a sex and age-matched non-cancer control group. There was a significant elevation of plasma levels of TAT (p <0.001), F1+2 (p <0.001), D-dimer (p <0.0001) and FVIIa (p <0.05), as well as an increase of FVII proteolysis (p <0.05), whereas plasma PC and AT concentrations were not different from controls. After starting chemotherapy, markers of clotting activation were progressively lower in the group receiving warfarin prophylaxis compared to the group on placebo. Differences between the groups became statistically significant (p <0.01) after the 4th course of chemotherapy. Deep vein thrombosis occurred in two patients in the placebo arm. The results of this study indicate that before therapy, an hypercoagulable state is present in stage IV breast cancer, and after starting chemotherapy, abnormalities of hypercoagulation markers persist, however they are reduced by very-low-dose-warfarin. None of the laboratory variables could predict thrombosis in the single patient.

第4回継続教育コース・医学図書館研究会報告

第4回継続教育コース・医学図書館研究会報告

A laboratory for power systems control with static converters

The 4th year course 'Power Systems Control' at the University of Toronto includes a laboratory familiarizing the student with the function and use of static converters for the control of power systems. This paper describes the concept of the laboratory and the required equipment. The experiments are discussed in detail to demonstrate the possibility to teach the different aspects of power systems control with static converters.

Postoperative irradiation combined with chemotherapy for high-risk rectal cancer patients

In a prospective open-study we evaluated the combination of radiation therapy and adjuvant 5-FU plus levamisole in controlling Modified Astler-Coller (MAC) B2 or C rectal cancer following a curative-intended surgery. Sixty-four consecutive rectal cancer patients were treated by adjuvant radiation therapy (Linac 8 MV, 50-50.4 Gy to an isocentric pelvis brick volume in 5 fractions per week each of 1.8-2 Gy), and 12 monthly courses of 5-fluorouracil (375 mg/m(2)/day for 5 consecutive days) plus levamisole (50 mg t.i.d. for 3 days). Within a median follow-up period of 36 months, 19 patients (29.6%) experienced relapses. The 3-year-DFS of MAC B2 patients was 82%, compared with 60% in MAC C. Early radiation treatment was not associated with a higher proportion of relapses, while late radiation therapy initiation was associated with a significantly higher proportion of relapses. Early radiation therapy, not later than following the 2nd to 4th course of chemotherapy, is associated with the more acceptable proportion of relapses.

Secreting germ cell tumors of the central nervous system (CNS). First results of the cooperative German/Italian pilot study (CNS sGCT).

Secreting germ cell tumors are an invariably fatal subgroup within the malignant pediatric brain tumors. Thus in 1993, an international working group was initiated to establish a cooperative study for diagnostic and treatment of intracranial secreting germ cell tumors of the CNS. To pilot this protocol, since 1994 German and Italian patients are treated in accordance with the established guidelines. Regarding to the achieved consensus within the international protocol committee a characteristical diagnostic imaging (CT/MRI scan) of head and spine and a significant increase of tumor markers beta-HCG (> 50 IU/l) and/or AFP (> 25 ng/ml) are defined as sufficient diagnostic criteria. Additionally staging procedures include an initial CSF cytology. Treatment consists of 4 courses PEI: platinum (20 mg/m2 day 1-5), VP16 (100 mg/ m2 day 1-3), and ifosfamide (1.5 g/m2 day 1-5). Surgery of the residual tumor is administered after chemotherapy, if resection is possible, followed by craniospinal irradiation (30 Gy with tumor boost 24 Gy). Until September 96, 19 patients (16 boys and 3 girls) aged 8 to 19 years are registered and have finished their treatment. Seven children are diagnosed by elevated tumor markers. Six of 7 children with stereotactic fine needle biopsy and histology of germinoma have a significant marker increase as a specific characteristic for secreting non-germinomatous germ cell tumors. In 6 patients, the tumor is primarily resected, 2 children are biopsied. In 2 children spinal metastases are diagnosed initially. Tumor marker response is evaluated in 16 children. Thirteen of 16 patients show a clear marker normalization after 2 courses of PEI. One boy with a slight increase of the tumor marker after the 4th course developed an early spinal relapse and died. One girl showed a spinal recurrence during focal radiotherapy. She is still under relapse treatment. A significant decrease of tumor volume after chemotherapy is documented in 10/13 children, who have a definite signal tumor at start of therapy. In 3 children tumor volume does not change despite of marker normalization. Histology of these tumors is teratoma. One of these children died postoperatively because of tumor bleeding. 17/19 patients are alive, 16 of them are in complete remission with a median follow-up of 11 months. These results show a further significant increase of event-free survival (EFS 81%). The piloted chemotherapy is proven to be effective and the protocol is now open as an international SIOP CNS GCT study that is started in October 1996.