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2.  High dose chemotherapy for 3-6 cycles, followed by enucleation or
                              extended enucleation, external beam radiotherapy, and continued

                              chemotherapy for 12 cycles

                       F.   Regional Lymph Node Metastasis, International Staging, Stage IIIB
                          1.  Baseline evaluation for systemic metastasis

                          2.  Neck dissection, high dose chemotherapy for 6 cycles, followed by
                              external beam radiotherapy, and continued chemotherapy for 12
                              cycles

                       G.   Hematogenous  or  Central  Nervous  System  Metastasis,  International  Staging,

                          Stage IV
                          Palliative therapy in discussion with the family

                   Standard Operating Procedure
                   a.  In-Patient :
                         Admit patients for surgery and chemotherapy

                         Admit patients with complications following chemotherapy

                   b.  Out Patient: All older children who can cooperate for examination
                   c.  Day  Care:  All  children  undergoing  examination  under  anesthesia  and  focal
                       treatment.

                   c)  Referral criteria: not applicable




               VI. WHO DOES WHAT? AND TIMELINES

                     a.  Doctor :


                          Patient history is taken and a clinical examination performed
                          Documenting the medical record
                          Plan treatment guidelines and perform surgery if necessary.
                          Awareness of public and medical personnel



                     b.  Nurse/Technician:

                          Perform lab tests
                          To monitor the patients who are admitted
                          To maintain separate inpatient and outpatient record

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