CASE REPORT
A 2-year-old boy was diagnosed with CCSK, which relapsed 4 times until he yielded to disease at the age of 7 years (Fig. 1, Supplementary Fig. S1). At diagnosis, the primary tumor site was the right kidney (Stage-I). He received chemotherapy consisting of actinomycin D, vincristine and, doxorubicin (DD-4A) followed by radiotherapy (10.8Gy/6Fr) after a right partial nephrectomy. This combination therapy successfully induced complete remission. However, 4 months after the completion of treatment, first relapse occurred at his left lung. He received 6 courses of chemotherapy consisting of ifosfamide, carboplatin, and etoposide (ICE) with radiotherapy (12Gy/8Fr) after a left upper lobectomy, and then achieved second remission. At the age of 5 years, second relapse developed at the abdominal lymph nodes. A total excision was done after three courses of chemotherapy consisting of cyclophosphamide, vincristine, pirarubicin, and cisplatin. Postoperative chemoradiotherapy induced third remission. At the age of 6 years, he suffered from third relapse at the para-aortic lymph nodes. The patient underwent a subtotal excision of these lymph nodes followed by high dose chemotherapy (busulfan and melpharan) with autologous hematopoietic stem cell transplantation (aHSCT). The patient achieved fourth remission; however, four months later, fourth relapse occurred at the ascending colon, small intestine, duodenum, pancreas, and right hepatic lobe, and he yielded to the advanced disease.