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Although the incidence of childhood cancer is extremely low, it remains the second
most common cause of death in children over the age of 1 year. Today, two-thirds of
children with access to optimal medical treatment are cured of cancer, but the different
types of cancer have highly variable cure rates. As determined by the German National
Cancer Registry, children with Hodgkin's disease, retinoblastoma, and Wilms' tumour
all have a 5-year survival rate of 86% or higher. Patients with acute lymphocytic
leukaemia, non-Hodgkin's lymphoma, and germ cell tumours also have a favourable long-term
prognosis, but children with many of the subtypes of acute myeloid leukaemia, central
nervous system tumours, neuroblastoma, and hepatic tumours continue to have a poor
prognosis. Depending on the type of cancer and the stage at which it is diagnosed,
children may be treated with one or more modalities, including chemotherapy, radiotherapy,
and surgery. Various combinations of chemotherapeutic agents have been extremely effective
in inducing, consolidating, and maintaining remission. Advances in orthopaedic surgery
have reduced the number of therapeutic amputations that are performed and made possible
the administration of smaller doses of radiation. A growing knowledge of the immunohistological,
genetic and molecular characteristics of many types of cancer have facilitated the
accurate diagnosis and stratification of patients into risk groups. As a result, children
can receive individualised treatment and many low-risk patients can receive less intensive
therapy, thus avoiding some of the late sequelae of intensive cytotoxic therapy, such
as severe organ damage, infertility, and second malignancies.
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© 1997 Published by Elsevier Inc.
