What are the goals of childhood cancer treatment?

Author:  Gesche Tallen, MD, PhD, Editor:  Maria Yiallouros, Reviewer:  Prof. Dr. med. Dr. h.c. G. Henze, English Translation:  Hannah McRae, Last modification: 2012/04/25 https://kinderkrebsinfo.de/doi/e73736

The goals of childhood cancer treatment can vary. It is dependent on the type of cancer, if it is the first diagnosis or recurrent disease, the extent of the cancer, possible spread (metastasis), and often also on the patient's age.

For most patients, the primary treatment goal is to completely and permanently eliminate all cancer cells from the child's organism (curative treatment approach). Until the late 60ies, "your child has cancer." sounded like a a death sentence, because the chance of cure was below 20% for children and teenagers with this disease. To date, more than 75% of all childhood cancer patients in industrialised nations survive longer than 5 years. This dramatic success is a consequence of intensive basic and clinical research, mostly in the framework of multicentred, prospective clinical studies.

However, despite continously optimised treatment standards, it is still about 25% of all children and teenagers with cancer who might not survive. This could, for example, be a direct consequence of their disease, or due to side-effects of the intensive therapy, or because their cancer does not respond to the treatment (nonresponse). Sometimes, a cancer even growths back after a primarily successful treatment (recurrent disease; relapse). Depending on the patient's individual situation, another intensive treatment with a curative intention may be recommended for some children, while for others, a form of treatment that mainly aims at reducing disease-related symptoms rather than killing the cancer might be more appropriate (palliative treatment approach).

In general, every cancer can relapse, even if no more cancer cells were detectable at the end of the primary intensive treatment (firstline therapy). The reason for recurrent disease is, that single cancer cells can survive firstline therapy, and suddenly start dividing again after a certain time of growth arrest.

Thanks to intensive childhood cancer research, specific methods have been developed, with which such surviving cancer cells (minimal residual disease, MRD) can be detected early, so that another treatment can be initiated as soon as possible. Such methods are already being successfully used during treatment and follow-up of patients with childhood acute lymphoblastic leukaemia (ALL).

Like the goals of firstline therapy (see above), treatment goals for young patients with a relapsed cancer can also vary. Depending on many individual factors, such as type of cancer, type of firstline treatment, timepoint and extent of recurrent diesease, the patient's individual risk-factors, to name a few, relapse treatment may have a curative or a palliative intention.