![]() However, more recently, it has become evident that chemotherapy is also associated with long-term side effects, including late myocardial damage due to anthracyclines, nephrotoxicity due to cisplatin or ifosfamide, and secondary leukaemia related to a number of chemotherapeutic agents including alkylating agents. Increasing awareness of long-term effects in the 1970s and 1980s led to a general decline in the use of radiotherapy. Long-term effects of radiotherapy include impaired bone and soft tissue growth, impaired neuropsychological development as a result of irradiation of the central nervous system (CNS) and radiation-induced malignancy. Cure, however, often comes ‘with a cost’ as a result of the long-term sequelae of treatment. Radiotherapy is an important modality of therapy in local tumour control and the majority of paediatric tumours are radiosensitive. Since the introduction of chemotherapy into treatment programmes in the 1960s and 1970s, the proportion of children surviving cancer has shown a gratifying increase.Īpproximately 40–50% of children with cancer receive radiotherapy as part of their initial treatment. For most diseases, this has been brought about largely as a result of the incorporation of chemotherapy as part of a multimodality approach, including surgery and radiotherapy. Increasingly, collaboration is across European boundaries, with clinical trials coordinated via the International Society of Paediatric Oncology (SIOP).Ĭurrently, approximately two-thirds of children treated for cancer can expect to be long-term survivors. In the UK, treatment is coordinated by the network of twenty-two Children’s Cancer and Leukaemia Group (CCLG) (formerly UKCCSG) paediatric oncology centres. In 1999, these were amalgamated to form the Children’s Oncology Group (COG), the largest paediatric oncology collaborative group in the world. In North America, clinical research has been coordinated via the Paediatric Oncology Group (POG), Children’s Cancer Group (CCG), Intergroup Rhabdomyosarcoma Study Group (IRSG) and National Wilms’ Tumour Study Group (NWTS). Paediatric oncology collaborative groups have been very successful at entering a high proportion of children into clinical trials. The evolution of the multidisciplinary care of children with cancer has been one of the success stories of modern oncology. Table 33.1 Surveillance, epidemiology and end results (SEER) programme registrations 1975–2001, annual incidence rate per 1 000 000 and proportion of children aged 0–14 with cancer ![]() Table 33.1 summarizes data on relative incidence of the various tumour types from the US Surveillance, Epidemiology and End Results (SEER) programme. The range of childhood cancers is very different from that seen in the adult population. Approximately one individual child in 500 will develop cancer before the age of 15. In the UK, approximately 1500 children below the age of 15 develop cancer each year. Future incorporation of molecular subgroups into treatment protocols will hopefully improve both survival outcomes and posttreatment quality of life.Ĭhemotherapy embryonal tumor medulloblastoma pediatric brain tumor posterior fossa mass.Cancer in childhood is uncommon. ![]() Recent molecular subclassification of medulloblastoma has potential prognostic and therapeutic implications. Treatment for medulloblastoma is associated with significant morbidity, especially in the youngest patients. Outcomes are inferior in infants and children younger than 3 years with exception of those patients with the medulloblastoma with extensive nodularity histologic subtype. Patients >3 years old are stratified based on the volume of postoperative residual tumor and the presence or absence of metastases into "standard risk" and "high risk" categories with long-term survival rates of approximately 85% and 70%, respectively. Treatment includes a combination of surgery, radiation therapy (in patients >3 years old). These tumors occur exclusively in the posterior fossa and have the potential for leptomeningeal spread. Medulloblastoma accounts for nearly 10% of all childhood brain tumors.
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