Cures in Childhood Cancer
Allen R. Chauvenet MD, PhD1
Marcia M. Wofford MD1
1 Assistant Professor of Pediatrics, Brenner Children's Hospital, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC.
Dramatic advances have been made in the treatment and potential cure of childhood cancer in the past two decades. In the case of the most common childhood malignancy, acute lymphoblastic leukemia, Mauer wrote in 1969 that he did "not think that the attempt to encourage parents by discussion of the possibility of a cure being found is any real help to the parents in facing the inevitable consequences of this disease." By 1973, Pochedley, while noting that the great majority of patients would die from disease, commented that "remissions can last five or more years and in a few patients they seem to be permanent." In 1989, Poplack stated that "about 60% of children with this disease achieve prolonged disease-free survival (over 5 years from diagnosis) and most of these patients are considered to be cured."
In this review, data are presented in support of the conclusion that cures can be found for oven half of the children in this country in whom the diagnosis of cancer is made. The focus is not on clinical presentations but on staging systems, treatment principles, and outcomes for the most common pediatric malignancies.
DATA ANALYSIS AND POTENTIAL BIAS IN DATA
In the United States, the great majority of children with cancer are treated by pediatric hematologists/oncologists who are members of a cooperative study group (the Pediatric Oncology Group and the Children's Cancer Study Group); major reports of treatment results are based on data concerning children participating in groupwide, multi-institution studies, in single large institutions (usually with affiliates), or in intergroup studies.
