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Radiotherapy in tumors of childhood
17. Daviss WB, Monney D, Racusin R, Ford JD, Fleischer A, McHugo GJ. Predicting post-traumatic stress after hospitalization for pediatric injury. J Am Acad Child Adolesc Psychiatry 2000;39:576-83. 18. Wolfe D, Sas L, Werkerle C. Factors associated with the development of posttraumatic stress disorder among child victims of sexual abuse. Child Abuse Negl 1994;18:37-50.
19. Livingston R, Lawson L, Jones J. Predictors of self-reported psychopathology in children abused repeatedly by a parent. J Am Acad Child Adolesc Psychiatry 1993;32:948-53. 20. Stuber ML, Nader KM, Yasuda P, Pynoos RS, Cohen S. Stress responses after pediatric bone marrow transplantation: preliminary results of a prospective, longitudinal study. J Am Acad Child Adolesc Psychiatry 1996;30:6.
50 Years Ago in The Journal of Pediatrics RADIOTHERAPY IN TUMORS OF CHILDHOOD Phillips RF, Dargeon HW. J Pediatr 1954;44:448-68 Phillips and Dargeon provided an excellent overview of the progress of radiotherapy in the treatment of childhood cancer since Roentgen’s discovery in 1895. At the time, even short-term remissions for childhood cancer were rare, and radiotherapy was the most ‘‘formidable’’ therapeutic option available, although the actual value of ionizing radiotherapy was uncertain. Combination modality therapy (chemotherapy and radiotherapy) was considered desirable but unproven, so the authors advocated increased use of radiotherapy in the treatment of childhood cancer. They admitted, however, that the knowledge needed to treat childhood cancer scientifically was ‘‘pitifully inadequate.’’ During the last 50 years, through cooperative multicenter research studies, our knowledge has improved greatly. Through better surgical and diagnostic techniques and combined modality therapy, short- and long-term remissions of childhood malignancy are now common. The utility of radiotherapy was clearly demonstrated in 1971 when prophylactic whole-brain radiation was shown to greatly improve the survival of children with acute lymphoblastic leukemia.1 In 1954, the knowledge of long-term side effects of radiation was inadequate. Certain complications such as dry skin, cataracts, and pulmonary fibrosis had been recognized, but survival of children with cancer was so poor that the long-term sequelae were not fully appreciated. Now that most children are surviving, long-term complications such as neurocognitive disabilities, hormonal dysfunction, growth abnormalities, and secondary sarcomas, have become apparent. In large part due to these complications, radiotherapy has decreased in importance. For example, radiotherapy in 1954 was standard therapy for Wilms’ tumor. However, the results of the National Wilms’ Tumor Study Group research conducted since 1969 have allowed for the elimination of radiotherapy from all except the most advanced stage patients, and survival has continued to improve.2 As predicted in 1954, improvements in radiotherapy methods and changes in its indications have been dramatic. Our hope is that through continued cooperative studies, treatments will continue to improve survival of childhood cancer while further decreasing both acute and long-term side effects. Anderson B. Collier, III, MD Department of Pediatrics The University of Texas Southwestern Medical Center at Dallas Dallas, TX 75390-9063 YMPD727 10.1016/j.jpeds.2004.01.018
REFERENCES 1. Aur RJ, Simone J, Hustu HO, Walters T, Borella L, Pratt C, et al. Central nervous system therapy and combination chemotherapy of childhood leukemia. Blood 1971;37:272-81. 2. Neville HL, Ritchey ML. Wilms’ tumor: overview of National Wilms’ Tumor Study Group results. Urol Clin North Am 2000;27:435-42.
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The Journal of Pediatrics April 2004
19. Livingston R, Lawson L, Jones J. Predictors of self-reported psychopathology in children abused repeatedly by a parent. J Am Acad Child Adolesc Psychiatry 1993;32:948-53. 20. Stuber ML, Nader KM, Yasuda P, Pynoos RS, Cohen S. Stress responses after pediatric bone marrow transplantation: preliminary results of a prospective, longitudinal study. J Am Acad Child Adolesc Psychiatry 1996;30:6.
50 Years Ago in The Journal of Pediatrics RADIOTHERAPY IN TUMORS OF CHILDHOOD Phillips RF, Dargeon HW. J Pediatr 1954;44:448-68 Phillips and Dargeon provided an excellent overview of the progress of radiotherapy in the treatment of childhood cancer since Roentgen’s discovery in 1895. At the time, even short-term remissions for childhood cancer were rare, and radiotherapy was the most ‘‘formidable’’ therapeutic option available, although the actual value of ionizing radiotherapy was uncertain. Combination modality therapy (chemotherapy and radiotherapy) was considered desirable but unproven, so the authors advocated increased use of radiotherapy in the treatment of childhood cancer. They admitted, however, that the knowledge needed to treat childhood cancer scientifically was ‘‘pitifully inadequate.’’ During the last 50 years, through cooperative multicenter research studies, our knowledge has improved greatly. Through better surgical and diagnostic techniques and combined modality therapy, short- and long-term remissions of childhood malignancy are now common. The utility of radiotherapy was clearly demonstrated in 1971 when prophylactic whole-brain radiation was shown to greatly improve the survival of children with acute lymphoblastic leukemia.1 In 1954, the knowledge of long-term side effects of radiation was inadequate. Certain complications such as dry skin, cataracts, and pulmonary fibrosis had been recognized, but survival of children with cancer was so poor that the long-term sequelae were not fully appreciated. Now that most children are surviving, long-term complications such as neurocognitive disabilities, hormonal dysfunction, growth abnormalities, and secondary sarcomas, have become apparent. In large part due to these complications, radiotherapy has decreased in importance. For example, radiotherapy in 1954 was standard therapy for Wilms’ tumor. However, the results of the National Wilms’ Tumor Study Group research conducted since 1969 have allowed for the elimination of radiotherapy from all except the most advanced stage patients, and survival has continued to improve.2 As predicted in 1954, improvements in radiotherapy methods and changes in its indications have been dramatic. Our hope is that through continued cooperative studies, treatments will continue to improve survival of childhood cancer while further decreasing both acute and long-term side effects. Anderson B. Collier, III, MD Department of Pediatrics The University of Texas Southwestern Medical Center at Dallas Dallas, TX 75390-9063 YMPD727 10.1016/j.jpeds.2004.01.018
REFERENCES 1. Aur RJ, Simone J, Hustu HO, Walters T, Borella L, Pratt C, et al. Central nervous system therapy and combination chemotherapy of childhood leukemia. Blood 1971;37:272-81. 2. Neville HL, Ritchey ML. Wilms’ tumor: overview of National Wilms’ Tumor Study Group results. Urol Clin North Am 2000;27:435-42.
484
Connolly et al
The Journal of Pediatrics April 2004