Journal of Paediatric Medicine & Surgery
Open Access

Pediatric cancer; Chemotherapy; Radiotherapy; Immunotherapy; Leukemia; Precision medicine; Childhood oncology

Introduction

Cancer in children, while constituting a small percentage of overall cancer cases, presents a significant clinical challenge due to the unique biological and physiological considerations involved. Approximately 300,000 children and adolescents under 19 years of age are diagnosed with cancer globally each year. The most common childhood cancers include leukemia, brain tumors, neuroblastoma, and lymphomas. While advancements in oncology have dramatically improved survival rates, treatment is often complicated by long-term health issues that arise from the aggressive therapies employed. This article reviews the current treatment options for pediatric cancer, evaluates their efficacy, and explores future advancements aimed at improving survival while minimizing long-term harm [1,2].

Background

Pediatric cancers differ from adult cancers in their types, treatment responses, and prognosis. The majority of childhood cancers are the result of genetic mutations rather than lifestyle factors. Common types of pediatric cancers include:

• Leukemia: Acute Lymphoblastic Leukemia (ALL) is the most common childhood cancer, accounting for approximately 30% of cases.
• Brain tumors: These are the second most common, with medulloblastoma and gliomas being prevalent in children.
• Neuroblastoma: A cancer of the sympathetic nervous system, primarily affecting infants and very young children.
• Lymphomas: Both Hodgkin and non-Hodgkin lymphomas can occur in children and differ from adult forms of the disease [3,4].

The treatment of pediatric cancers involves a multidisciplinary approach that includes chemotherapy, radiation therapy, surgery, and increasingly, newer treatments such as targeted therapies and immunotherapy. These therapies, while often effective, can lead to significant side effects that affect the child's quality of life, necessitating a careful balance between treatment efficacy and long-term safety.

Treatment modalities

Chemotherapy

Chemotherapy remains the cornerstone of pediatric cancer treatment, particularly for leukemia and solid tumors. Pediatric regimens are tailored to the type and stage of cancer and aim to maximize cure rates while minimizing toxicity. Doses are calculated based on body surface area to account for children's smaller size and developing organs. However, chemotherapy can cause significant side effects, including nausea, immunosuppression, and organ damage. Long-term consequences, such as infertility and secondary malignancies, remain a concern [5,6].

Radiotherapy

Radiation therapy is employed in the treatment of various childhood cancers, such as brain tumors and Hodgkin lymphoma. Advances in radiation delivery techniques, including intensity-modulated radiation therapy (IMRT) and proton therapy, allow for more precise targeting of tumors while sparing healthy tissues. However, radiation exposure in children can result in developmental delays, endocrine disorders, and an increased risk of secondary cancers, particularly in the brain and spinal cord [7].

Surgery

Surgical intervention plays a critical role in the treatment of many pediatric cancers, particularly solid tumors such as neuroblastoma and Wilms' tumor. Complete resection of the tumor is often the goal, but in some cases, surgery is combined with chemotherapy or radiation to shrink tumors before removal. Pediatric surgical oncology is highly specialized, with a focus on minimizing damage to surrounding tissues to preserve organ function.

Targeted therapies

The advent of precision medicine has led to the development of targeted therapies that attack specific molecular abnormalities in cancer cells. Drugs like imatinib for chronic myeloid leukemia (CML) and monoclonal antibodies such as rituximab for lymphomas have revolutionized pediatric oncology. Targeted therapies offer the potential for increased efficacy with reduced side effects compared to traditional chemotherapy, although their use in children is still being explored in clinical trials [8].

Immunotherapy

Immunotherapy, particularly chimeric antigen receptor (CAR) T-cell therapy, has emerged as a groundbreaking treatment for certain types of pediatric leukemia, especially in cases that have relapsed or are refractory to standard treatments. By harnessing the body's immune system to target cancer cells, immunotherapy offers a novel and effective approach with the potential for long-term remission. However, challenges remain, including managing immune-related side effects and the high cost of treatment.

Results

Survival rates for pediatric cancers have improved dramatically in recent decades, with five-year survival rates for childhood leukemia exceeding 85% in developed countries. The use of combination therapies—chemotherapy, surgery, and radiation—has been instrumental in these outcomes. However, survival varies significantly by cancer type. Brain tumors and certain high-risk neuroblastomas still have relatively poor prognoses, with five-year survival rates below 70%. Additionally, children who survive cancer face the possibility of long-term complications, including growth abnormalities, cognitive deficits, and secondary malignancies [9].

Discussion

The significant strides in pediatric cancer treatment underscore the importance of ongoing research in improving both survival and quality of life. Advances in molecular diagnostics have paved the way for precision medicine, which allows for the tailoring of treatment to each child's specific cancer type and genetic makeup. Nonetheless, significant challenges remain in the treatment of pediatric cancers, particularly concerning the long-term side effects of treatment. Chemotherapy and radiation therapy, while effective in eradicating cancer cells, often come with a high burden of toxicity, particularly for young children whose bodies are still developing. The risk of secondary cancers, infertility, and organ damage highlights the need for treatments that are both effective and less harmful. Immunotherapy and targeted therapies offer hope in this regard, but more research is needed to understand how best to integrate these approaches into pediatric care.

Conclusion

The treatment of cancer in children has made remarkable progress, with increasing survival rates across most cancer types. However, the long-term consequences of aggressive therapies remain a critical area of concern. Moving forward, the integration of precision medicine, targeted therapies, and immunotherapy holds promise for reducing treatment-related toxicity while maintaining or improving survival outcomes. Continued research, clinical trials, and a focus on survivorship care are essential to further enhancing the quality of life for pediatric cancer survivors.

1. Davis DL, Boster L (1988)Multifaceted therapeutic inervention with the violent psychiatric patient. Hospital and Community Psychiatry 39: 867-869.

Indexed at, Google Scholar, Crossref

2. Hovenkamp-Hermelink HM, Jeronimus FB, Myroniuk S, Riese H, Schoevers AR, et al. (2021)Predictors of persistence of anxiety disorders across the lifespan: a systematic review. Lancet Psychiat 8: 428-443.

Indexed at, Google Scholar, Crossref

3. Stein BM, Sareen J (2015)Clinical Practice: Generalized Anxiety Disorder. N Engl J Med 373: 590-568.

Indexed at, Google Scholar, Crossref

4. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, et al. (2014)Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ 348: 1151.

Indexed at, Google Scholar, Crossref

5. Peña MS, Yaltho TC, Jankovic J (2011)Tardive dyskinesia and other movement disorders secondary to aripiprazole. Mov Dis 26: 147-152

Indexed at, Google Scholar, Crossref

6. Scahill L, Chappell PB, Kim YS, Schultz RT, Katsovich L, et al. (2001)A placebo-controlled study of guanfacine in the treatment of children with tic disorders and ADHD. Am J Psychiatry 158: 1067-1074.

Indexed at, Google Scholar, Crossref

7. Leckman JF, Hardin MT, Riddle MA, Stevenson J, Ort SI, et al. (1991)Clonidine treatment of Gilles de la Tourette syndrome. Arch Gen Psychiatry 48: 324-328.

Indexed at, Google Scholar, Crossref

8. Porta M, Sassi M, Cavallazzi M, Fornari M, Brambilla A, et al. (2008)Tourettes Syndrome and Role of Tetrabenazine: Review and Personal Experience. Clin Drug Invest 28: 443-459.

Indexed at, Google Scholar, Crossref

9. Kenney CJ, Hunter CB, Mejia NI, Jankovic J (2007)Tetrabenazine in the treatment of Tourette syndrome. J Ped Neurol 5: 9-13.

Google Scholar, Crossref