Twenty-five years ago the outlook for children with cancer was poor. Fewer than 25% survived for three or more years. Rare exceptions to this grim experience included children with localized and totally resected Wilms' tumor and neuroblastoma and with stage I Hodgkin's disease, and the occasional patient with acute lymphoblastic leukemia (ALL). Major advances in diagnosis and treatment have increased cure rates to over 50% for all major childhood cancers except acute nonlymphoblastic leukemia, malignant brain tumors, and selected metastatic (stage IV) solid tumors. Major contributors to this success are the effective use of multimodality therapy, improved supportive care, and, more recently, the identification of clinical and biological prognostic factors that determine the relative intensity and duration of treatment.
It has been estimated that by 1990, 0.1% of all adults (1:1000) will be cured patients who had had pediatric cancer. Thus, physicians caring for children, adolescents, and young adults should be