Preface

The field of pediatric oncology has seen tremendous advances over the past decades. Particularly impressive is the fact that, for the majority of children who are diagnosed with cancer today, the diagnosis does not carry a death sentence. Most children diagnosed with acute lymphoblastic leukemia (ALL), Wilms tumor, Hodgkin disease, non-Hodgkin lymphoma, and germ cell cancer are expected to survive and be cured following therapy. The remarkable treatment success achieved in many pediatric cancers has more recently allowed investigators to start assessing what, if any, cost is associated with long-term survival. As described in this issue of Pediatric Clinics of North America, the price for cancer survivors is not insignificant in many cases. Moreover, it has become evident that the fact that these children “graduate” from pediatric oncology care and become adults generates a whole new set of challenges for continued follow up and after care. Increasingly, it has become apparent that clear guidelines are needed to ensure that children cured of their cancer have access to health care services tailored to their unique needs, many of which have only recently been identified.

For some children, survival remains a major challenge. Different avenues continue being explored to improve the outcome for children with metastatic cancers (eg, osteogenic sarcoma, neuroblastoma, rhaddomyosarcoma), for many who present with a central nervous system (CNS) tumor, and for those that relapse. Investigators continue to determine how we can best use stem cell transplantation and immunotherapy, both of which are discussed in this issue, in these high risk scenarios.

It is obvious that not every single aspect of childhood cancer could be included in an issue such as this one. Our choice for topics was guided by several factors. First, we felt that an update on leukemia (both ALL and acute myelogenous leukemia) was warranted because leukemia is the most common form of childhood cancer. Moreover, the field of leukemia has changed considerably, mostly as a consequence of new stratification strategies, which are extensively discussed. Second, we elected to update the readers on some cancers that remain a challenge to cure (eg, CNS tumors and neuroblastoma). Finally, we elected topics that generate broad interest in the pediatric oncology community, such as how best to conduct clinical trials (by many considered standard care), the role of obtaining assent to treat children and adolescents, and the challenges to integrate palliative care early on in the management of children with cancer.

Many of the contributions in this issue are authored by colleagues from different countries. This reflects that the world of pediatric oncology is shrinking. As survival rates improve, larger clinical trials will be necessary to demonstrate further gains in outcome. This will require enhanced international dialogue and collaboration, which is exciting because there is much we can learn from each other. We can only hope that the readers will experience some of the same stimulation we felt as we communicated with the authors and read their finalized contributions.