Pediatric Cancers

Ependymoma is a rare central nervous system (CNS) tumor in children, and our progress in treating this disease has been hampered by its rarity as well as by a nonuniform approach to treatment among practitioners. Dr. Merchant’s comprehensive review provides a framework for plotting a course of further progress in treating children with ependymoma.

Radiation therapy has long been a mainstay in the treatment of ependymoma. Concerns about the long-term effects of radiation therapy have made many parents and caregivers wary of this treatment modality. However, with the advent of conformal radiation and evidence

VIENNA, Austria-More than two thirds of children who have terminal cancer need opioids or other strong analgesics, most commonly oral morphine. Transdermal fentanyl patches (Duragesic) can replace oral morphine in many of these cases and also offer an alternative for patients who cannot take oral drugs, A. Goldman, MD, Institute of Child Health, London, said at the 9th World Congress on Pain.

Over the past 20 years, dramatic improvements have been made in the treatment of childhood malignancies. Today, most children who have cancer are expected to survive their disease and become healthy, productive members of society. Children with acute lymphoblastic leukemia (ALL) are a good example. Although pediatric ALL was an invariably fatal disorder in the past, children with this cancer now have a 5-year event-free survival rate of more than 70%.

Long-term neurotoxicity associated with central nervous system (CNS) prophylaxis for childhood acute lymphoblastic leukemia (ALL), primarily involving physical growth and cognitive development, is an ongoing

BUFFALO, NY--While most long-term survivors of childhood cancer suffer few psychological scars, up to 30% of fathers and 40% of mothers may exhibit moderate to severe symptoms of post-traumatic stress (PTS)--a disorder commonly associated with war veterans and victims of violent crime.

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