<p>The introduction of chemotherapy in the early 1960s followed by use of multimodal approach to therapy of solid tumours led to a dramatic improvement in the outcome of paediatric solid tumours. In addition refinements in chemotherapy (protocols using systemic multiple, non-cross-resistant drugs) and radiation therapy (3D conformal radiation therapy, IMRT and brachytherapy) have allowed for less radical or less mutilating operative intervention in many patients. Anterior or pre-operative cytoreductive chemotherapy has been clearly shown to improve resectability, and reduce blood loss and post-op complications and has changed the overall approach for many tumours. Advances in surgical techniques and intraoperative monitoring have also contributed to survival improvement. Techniques for chest wall reconstruction, prosthetic devices, and minimally invasive surgical procedures have contributed to improvement in outcome.</p><p>It is now amply clear that good local tumour control is as essential as systemic chemo-therapy for obtaining prolonged disease - free survival for childhood solid tumours. Local tumour control is obtained with surgical resection, radiation therapy or sometimes-in less favourable cases with combination of both. Tumour histology, location, treatment response, potential morbidity and functional outcome are all important factors that influence modality of local therapy. Because of the multimodal approach to these tumours and the importance of timing of various therapies, the surgeon has become a member of the patient's treating team. It is essential that at the time of initial evaluation, patients be evaluated by all disciplines (e.g., radiologist, medical, surgical and radiation oncologist and pathologist). The surgical oncologist who will perform the definitive surgery should be involved during the biopsy so that the incision can be placed in an acceptable location, especially if a limb salvage or organ preserving procedure is planned. The radiation oncologist and pathologist should be consulted prior to biopsy/surgery in order to be sure that the incision will not compromise the radiation port and so that multiple types of tissues samples are obtained as required. It is also crucial to complete all staging investigations prior to or at the time of any procedure, requiring anaesthesia.</p><p>The interface of cancer research with clinical practice in paediatric oncology has never been more intimate than today. Clinicians today, are using knowledge of oncogenes and tumour suppressor genes for diagnosing cancer in children, for therapeutic decision making purposes, and for prognostic purposes. The N-MYC gene amplification in neuroblastoma is a case in point, where presence of less than 10 copies is associated with the favourable outcome. Discovery and the use of biological agents like 13-cis retinoic acid in high risk neuroblastoma after myeloablative therapy have shown to add the survival of these patients.</p></sec></body></article></article></body></html>

IJMPO

Indian Journal of Medical & Paediatric Oncology

0971-5851

Indian Society of Medical & Paediatric Oncology

ijmpo-26-3-editorial-001

EDITORIAL

Paediatric Solid Tumours

Kapoor

Gauri

Department of Paediatric Oncology Rajeev Gandhi Cancer Institute Rohini, Sector-V, Delhi 110085

2005

26344

<p>The introduction of chemotherapy in the early 1960s followed by use of multimodal approach to therapy of solid tumours led to a dramatic improvement in the outcome of paediatric solid tumours. In addition refinements in chemotherapy (protocols using systemic multiple, non-cross-resistant drugs) and radiation therapy (3D conformal radiation therapy, IMRT and brachytherapy) have allowed for less radical or less mutilating operative intervention in many patients. Anterior or pre-operative cytoreductive chemotherapy has been clearly shown to improve resectability, and reduce blood loss and post-op complications and has changed the overall approach for many tumours. Advances in surgical techniques and intraoperative monitoring have also contributed to survival improvement. Techniques for chest wall reconstruction, prosthetic devices, and minimally invasive surgical procedures have contributed to improvement in outcome.</p><p>It is now amply clear that good local tumour control is as essential as systemic chemo-therapy for obtaining prolonged disease - free survival for childhood solid tumours. Local tumour control is obtained with surgical resection, radiation therapy or sometimes-in less favourable cases with combination of both. Tumour histology, location, treatment response, potential morbidity and functional outcome are all important factors that influence modality of local therapy. Because of the multimodal approach to these tumours and the importance of timing of various therapies, the surgeon has become a member of the patient's treating team. It is essential that at the time of initial evaluation, patients be evaluated by all disciplines (e.g., radiologist, medical, surgical and radiation oncologist and pathologist). The surgical oncologist who will perform the definitive surgery should be involved during the biopsy so that the incision can be placed in an acceptable location, especially if a limb salvage or organ preserving procedure is planned. The radiation oncologist and pathologist should be consulted prior to biopsy/surgery in order to be sure that the incision will not compromise the radiation port and so that multiple types of tissues samples are obtained as required. It is also crucial to complete all staging investigations prior to or at the time of any procedure, requiring anaesthesia.</p><p>The interface of cancer research with clinical practice in paediatric oncology has never been more intimate than today. Clinicians today, are using knowledge of oncogenes and tumour suppressor genes for diagnosing cancer in children, for therapeutic decision making purposes, and for prognostic purposes. The N-MYC gene amplification in neuroblastoma is a case in point, where presence of less than 10 copies is associated with the favourable outcome. Discovery and the use of biological agents like 13-cis retinoic acid in high risk neuroblastoma after myeloablative therapy have shown to add the survival of these patients.</p></sec></body></article></article></body></html>