Janeway Lecture: Pediatric cancer treatment: a model for oncology

Advances in pediatric oncology are reviewed using Wilms's tumor as a model. From the period when Wilms's tumor was treated by surgery alone to the time when adjuvant radiation and chemotherapy enabled attainment of an 80% survival rate, true collaboration among surgeons, radiation therapists, and pediatricians has been the key to success. The National Wilms's Tumor Study seeks to further refine treatment so that survival rates are maximized with minimum morbidity. The lessons applicable to all in cancer management are that a team approach is essential, all forms of treatment should be weighed early, treatment should be skilled and vigorous from the beginning the biology and natural history of the tumor should be considered in treatment planning, and toxicities of all forms of treatment should be respected and ways designed for their reduction.