Pediatric Cancers

For all the vast literature concerning survival after treatment for cancer, few articles provide long-term follow-up. At best, most provide 5-year survival statistics, the majority being actuarial, which means that many of the patients included do not even have 5-year follow-up. A few articles give 10-year data and call these long-term. But 5 or even 10 years is not a very long time for a child or young adult hoping for a normal life span, or for clinicians wishing to be able to predict a patient's prognosis after treatment.

The diagnosis and treatment of children with brain tumors has changed radically over the last 50 years. Cross-sectional imaging, CT and MRI, has displaced angiography and pneumoencephalography. These newer imaging modalities have facilitated early diagnosis, preoperative planning, and surgical approach, resulting in an increased likelihood of achieving complete surgical extirpation. The operating microscope has improved the experienced surgeon's ability to discriminate between tumor and normal brain, making radical resection more frequent. Chemotherapy has been introduced into the arsenal of the neuro-oncologist, albeit with only modest success. The one nearly constant treatment modality has been external-beam irradiation.

Outcome is described for 1,034 children who received radiation treatment in the management of a brain tumor at the University of Toronto Institutions from 1958 to 1995. The 5-, 10-, 20-, and 30-year relapse-free (or