Recent progress in pediatric oncology.

The significant progress made in pediatric oncology during recent years has been due to a major breakthrough in the field of molecular biology and the introduction of new therapeutic strategies that take into account both the quality and the duration of life. Molecular biology has already been instr umental in more fully categorizing the 'small round-cell tumor' group, and in reclassifying the 'Ewing family' tumors. It also provides a valuable too l for the prognostic evaluation of neuroblastomas through the analysis of t he N-myc oncogene. In addition, it has permitted the identification of the Li-Fraumeni syndrome of predisposition to cancer in the child, thereby rais ing the problematical ethical issue of communicating relevant information t o subjects at risk. Two examples illustrate innovative strategic concepts: 1) Burkitt's lymphoma, or an example of the successful de-intensification o f treatment; and 2) brain tumors in young children, regarding which the des ire to improve the quality of life has led to innovative attempts to replac e radiotherapy by chemotherapy. Considerable progress has been made in the field of neuropsychology, thereby permitting an imp,improved assessment of disorders and a better management of rehabilitation programs. New anti-canc er agents and also chemo- and radiotherapy that spare healthy tissue are al so being developed. Gene therapy and molecular biology will play a major ro le in future therapeutic strategies, and are now at the preclinical trial s tage. This significant overall progress leads to a reconsideration of the o rganizational approach toward treatment of the pediatric patient population suffering from cancer, and a critical assessment of disease management, wh ich should take into account not only the technical aspects of the disease but also familial and social considerations (C) 2000 Editions scientifiques et medicales Elsevier SAS.