The cancer death rate for children in the United States has declined sharply -- down 20 percent from 1990 to 2004 -- thanks to better treatment of leukemia and other cancers, health officials said on Thursday.
Cancer stands as the leading disease-related cause of death for U.S. children, the Centers for Disease Control and Prevention said in a report. Better treatments are improving survival rates, the CDC said.
The cancer death rate for U.S. children was 34.2 per million for children up to age 19 in 1990, but fell to 27.3 per million in 2004, the CDC said. This death rate has declined 1.7 percent per year during this period, according to the
Children with cancer are emotionally resilient-
The low levels of depression found in children with cancer using self-reporting and other traditional psychological testing led some researchers to believe different tests were needed to study this population, such as tests of posttraumatic stress disorder. Posttraumatic stress disorder is a disorder based on anxiety that follows a terrifying event or ordeal that either harmed or threatened to harm the person.
The diagnosis of posttraumatic stress disorder depends on the patient having certain symptoms from several different categories, such as experiencing flashbacks and nightmares; feeling detached; avoiding people or things linked to the trauma; losing interest in activities; and having difficulty sleeping.
But investigators found that most children with cancer did not have the full range of symptoms to indicate the disorder. Instead, they had a few of the symptoms that can occur, but not enough of them to qualify for the full diagnosis. This led other investigators to abandon these test and instead look for posttraumatic stress symptoms, even if those symptoms are too few to permit a diagnosis of posttraumatic stress disorder.
Phipps and his colleagues are also studying several other factors from the growing field of "positive psychology," such as optimism, benefit-finding, post-traumatic growth and the concept that people facing adversity might actually benefit and become stronger from it in many ways. "Research psychologists have historically focused on searching for problems that need fixing, rather than on a person's strengths," Phipps said. "However, our findings suggest that gaining a better understanding of how children are able to remain so well adjusted in the face of difficult life challenges may provide a more fruitful approach to our research," Phipps added.
Childhood cancer survival rates are improving all the time.
Laboratory tests suggest a new drug may prove effective in tackling three
types of childhood cancer, a scientific conference has heard.
The drug RH1 was able to kill tumour cells from neuroblastoma,
osteosarcoma and Ewing's sarcoma, all of which can be resistant to current
In a pre-clinical study, University of Manchester scientists found the
drug could boost cancer cell death by 50%.
resilience of most children with cancer isn't an illusion --
psychologically, they're doing better than most kids.That's the surprising conclusion of St. Jude's Children's Hospital
psychologist Sean Phipps, PhD.
"We see them as a flourishing population that has adapted to the stress of
having cancer and undergoing treatment," Phipps says in a news release.
"They become quite resilient to the long- and short-term emotional and
physical effects of their disease and the treatments."
World Cancer Day
announcement- Global Campaign To Help Parents Recognise The Signs-(Yahoo
Clinic helps child cancer survivors grappling
with effects later in life-(Associated Press-20/11/2005)
Nine-year-old Killian Owen was the first child to try an experimental leukemia treatment that was showing promise in adults — but the chance came too late. Yet the youngster left a precious legacy: Scientists are using his preserved cells to help create stronger drugs for other children desperate for new options. Killian’s saga illustrates both the pitfalls and promise of pediatric cancer research. Scientists are finding exciting leads, but few novel therapies for children are in the pipeline. When promising ones do come along, sick youngsters often must wait years for safety testing in adults to be done before they get a shot. “We’re always one step behind,” sighs Dr. Alan Wayne of the National Cancer Institute, who treated Killian with a drug called BL22 and is pushing for quicker clinical trials for children.
“The fact he was given a chance has led to so much hope for so many other children,” says Killian’s mother, Grainne Owen, who began a charity to spur pediatric cancer research. But, she adds, “You shouldn’t have to jump through the hoops we had to jump through to get our child to try a new drug.”
In a first, the Food and Drug Administration recently gave fast-track approval for a cancer drug for children to begin selling even before testing in adults is finished. The drug, Clolar, is to treat relapsed leukemia. FDA’s drug chief, Dr. Janet Woodcock, says she’s open to speeding through more child-first cancer treatments whenever those smallest patients have no good options. And a stark new report from the influential Institute of Medicine urges government and drug makers to cut children’s waiting time for access to experimental therapies — and for the NCI to actually develop those drugs if industry sees too little profit to do so. A “near absence” of pediatric cancer drug research “threatens to halt the progress in childhood cancer treatment achieved during the past four decades,” the report warns.
Childhood cancer survival is at an all-time high, with 80 percent of patients now cured. But more than 2,000 children a year still die, making cancer the leading pediatric killer disease.
While much of the progress came from mixing-and-matching adult chemotherapies in young patients, specialists agree it will take more novel approaches to help the remaining hardest-to-treat children. That’s because even cancers with the same name can act differently in children than in adults. But there are so many more adult patients that it’s not profitable for drug companies to pursue pediatric cancer aggressively, the IOM report says. Indeed, a recent industry survey shows 32 products being tested for childhood cancers; about half are already sold for adults, and the rest are in more advanced testing for adults than for children.
“If a drug cures 300 cancers a year, who’s going to pay for that drug?” asks Dr. Lee Helman, NCI’s pediatric oncology chief. “It’s going to be a societal problem.” Still, scientists hot on the trail of so-called targeted therapy — ways to attack the molecular differences that make some cancers more aggressive — are trying to speed children’s access to early stage research studies. Some examples:
Killian’s saga shows why awaiting adult research can backfire: He was given a fraction of the adult BL22 dose, standard procedure for early pediatric testing even though children’s faster metabolism often requires a higher dose, explains Wayne. “Clearly the Owens made progress in opening the logjam,” for children, he says. “The pendulum is swinging. ... The problem is it’s never fast enough.”
Cancer does not doom youngsters to a miserable childhood, new research suggests, finding that after treatment many are just as happy and well adjusted as those who never had the illness-sometimes even more. The findings based on interviews with 8-12 year olds, show how resilient youngsters can be even when facing something as frightening as cancer. The results also indicate that children's perceptions differ from their parents whose negative feelings may shade how they think their children are coping. Parents should be encouraged to know that young survivors can indeed put their cancer behind them.
90 children were questioned who had been successfully treated for cancer at least a year earlier, 72 undergoing treatment and a control group of 481 who had never had children. The questions focused on physical issues, including pain and activity restrictions, psychological functioning including fear of death, worrying and feeling inferior and outlook on life, including happiness and optimism. Children undergoing treatment had lower overall scores than both other groups. But the survivors overall scores were high, averaging 4.15, slightly above the 4.05 average for the control group.
Researchers find bills and ailments hound those treated in the '70s and '80s. Two out of three children who beat cancer go on to develop other chronic health problems, ranging from heart disease to blindness, because of radiation and other treatments that saved their lives, new research finds. Cancer treatments have vastly improved in recent years, so today's patients shouldn't suffer as many future problems, specialists say. Nevertheless, the research shows the tremendous medical, financial and emotional burdens that those treated in the 1970s and 1980s are now facing. One study found that 1 in 10 survivors are saddled with $25,000 in cancer-related debt.
"We've concentrated so much on our 5- and 10-year survival that we haven't paid attention to the impact of our treatments," said Dr. Len Lichtenfeld, deputy medical director of the American Cancer Society. Indeed, survival is at an all-time high. More than 3 out of 4 children are cured of cancer today, up from 58 percent in 1975. "But the individuals cured currently pay a large and unacceptable price for that," said Dr. Harmon Eyre, the cancer society's medical director. Nearly 10 million Americans have survived cancer, including 270,000 who were diagnosed when they were 15 or younger.
Childhood cancer can lead to chronic health problems later in life: study-(Yahoo
Close to 25 percent had multiple health problems by that point, and some 40 percent had suffered at least one severe, life-threatening, or disabling event or condition.The most serious repercussions of their early struggles with cancer and its treatment with chemicals, radiation and surgery included secondary cancers, obesity, infertility, neurological problems, and learning, behavioural and hormonal disorders.The investigators found that children who had been treated for bone tumours had the most health problems to contend with down the road - far more than kids who beat leukemia or Wilms tumour (a tumor of the kidney).
Their analysis also showed that radiotherapy, as a stand-alone treatment, was associated with a much higher disease burden later in life than either stand-alone chemo or drug therapy or stand-alone surgery.More than half the children in the study who underwent radiation treatment had a high or severe burden of illness by the time they were young adults, compared to 25 percent of patients who had surgery, and 15 percent of kids who got medication only.
That finding may reflect that fact that radiation damages healthy tissue in addition to zapping cancer cells, which increases the risk for secondary cancers, according to the lead author of the paper, Huib Caron, a professor of pediatric oncology at Emma Children's Hospital in Amsterdam in the Netherlands.Ultimately, the findings show that early, life-saving interventions come at a price - one that can take a heavy toll on the survivors' quality of life, and reduce their life expectancy.The results emphasise the need for ongoing monitoring of young cancer patients so subsequent problems can be diagnosed and treated early, the authors said.
The research looked at the prevalence of high-voltage power cables near children's homes. Children born or living near the power lines were 1.7 times more likely to contract leukaemia than those in the control group, the research found. Some studies have already shown an association between some types of electromagnetic fields and increased childhood leukaemia. Research author Dr Gerald Draper said other research suggested power lines might account for 20 to 30 of 500 cases of childhood leukaemia each year. But, he said, his work indicated a far smaller number of cases were affected. The findings were "surprising" and prompted further research, he added. The Department of Health said it would not comment on the findings until Dr Draper submitted his final report.
A new study suggests that eating more vegetables, fruit and protein before pregnancy may lower the risk of having a child who develops leukemia, the most common childhood cancer in the United States. "This is the first time researchers have conducted a systematic survey of a woman's diet and linked it to the risk of childhood leukemia," said Dr. Kenneth Olden, director of the National Institute of Environmental Health Sciences, the federal agency that funded the study. NIEHS is a component of the National Institutes of Health. The study was conducted by researchers at the University of California, Berkeley, and the study results are published in the August 2004 issue of Cancer Causes and Control.
Researchers compared 138 women who each had a child diagnosed with acute lymphoblastic leukemia (ALL) with a control group of 138 women whose children did not have cancer. The children of all the women in the study were matched by sex, age, race, and county of residence at birth. After comparing the women's diets in the 12 months prior to pregnancy, researchers found that the higher the intake of vegetables, fruit and foods in the protein group, the lower the risk of having a child with leukemia. One of the more surprising results of the study is the emergence of protein sources, such as beef and beans, as a beneficial food group in lowering childhood leukemia risk. "The health benefits of fruits and vegetables have been known for a long time," said principal investigator Gladys Block, professor of epidemiology and public health nutrition at U.C. Berkeley. "What we found in this study is that the protein foods group is also very important."
The researchers looked further and found that glutathione was the nutrient in the protein group with a strong link to lower cancer risk. Glutathione is an antioxidant found in both meat and legumes, and it plays a role in the synthesis and repair of DNA, as well as the detoxification of certain harmful compounds. Within the fruit and vegetable food groups, certain foods - including carrots, string beans and cantaloupe - stood out as having stronger links to lower childhood leukemia risk. The researchers point to the benefits of nutrients, such as carotenoids, in those foods as potential protective factors. National guidelines recommend that people eat at least five servings of fruits and vegetables every day, and two to three servings of foods from the protein group.
"Fetal exposure to nutritional factors has a lot to do with what mom eats," said Christopher Jensen, a nutritional epidemiologist at U.C. Berkeley and lead author of the paper. "These findings show how vital it is that women hoping to get pregnant, as well as expectant moms, understand that critical nutrients in vegetables, fruit and foods containing protein, such as meat, fish, beans and nuts, may protect the health of their unborn children."
The few studies that have been conducted on maternal diet and childhood cancer risk looked only at specific foods or supplements, and results have been mixed. This study is the first attempt to capture a woman's overall dietary pattern - using a 76-food-item questionnaire - and its relationship to the development of leukemia in a child. Researchers also studied the use of vitamin supplements, but did not find a statistically significant link to childhood leukemia risk. A growing number of scientists believe that genetic changes linked to cancer later in life begin in the womb. "It goes back to the old saying to expectant mothers, 'You're eating for two,'" said co-author Patricia Buffler, U.C. Berkeley professor of epidemiology and head of the federally funded Northern California Childhood Leukemia Study. "We're starting to see the importance of the prenatal environment, since the events that may lead to leukemia are possibly initiated in utero. Leukemia is a very complex disease with multiple risk factors. What these findings show is that the nutritional environment in utero could be one of those factors."
Living near a fuel station may quadruple the risk of acute leukemia in children, research published on Thursday showed French scientists who carried out a study of more than 500 infants found that a child whose home was near a fuel station or vehicle-repair garage was four times as likely to develop leukemia as a child whose home was further away. And the longer a child had lived nearby, the higher the risk of leukemia seemed to be, showed the research, published in the Occupational and Environmental Medicine journal.
The prevalence of childhood leukemia is four in every 100,000 children, but it is the most common type of childhood cancer in developed countries, say the researchers. Few clear risk factors have been identified for the childhood variant, but exposure to benzene in the workplace has been identified as a possible factor in leukemia in adults, the authors say. The risk appeared to be even greater for acute non-lymphoblastic leukemia, which was seven times more common among children living close to a fuel station or commercial garage, the research showed.
A nine-year-old boy with leukaemia has inspired a video game to help children understand and deal with cancer. In many ways, Ben Duskin is a typical American nine-year-old, playing video games whenever time, or his mother, will allow. But Ben is also unusual, because he is able to say he has designed one of his very own. When Ben was five, he was diagnosed with leukaemia, and his mother tried to explain his treatment by likening it to the classic Pac Man video game, gobbling up the bad cancer cells. But the problem was that Ben had never played Pac Man, and so he decided a new game was needed for children with cancer, to help them understand and deal with their illness.
He put this request to the Make a Wish charity in San Francisco, causing them a great deal of heartache, according to the head of the office, Patricia Wilson. "Some people almost laughed when I presented the request," she told the BBC programme Go Digital, "just saying do you understand what you're asking for? This is not possible, this is millions of dollars. This will take several years in the development." Just when it seemed Ben's wish was too much to ask for, someone stepped forward and offered to make it happen. That person was Eric Johnston, a programmer with LucasArts video games. He worked with Ben every week over the months to create the game just how the boy wanted it.
"Ben knew about the different side effects he wanted to portray in the game," said Mr Johnston. "He knew there would be attributes that the player would have - health from the hospital, ammo from the pharmacy and attitude, which you get from home. And as you go through the game you hit some setbacks - electrified barriers - which makes you lose some attitude, which according to Ben is pretty much how it works."
The free game, which shows Ben whizzing around the screen on his skateboard, has already been downloaded more than 35,000 times. Eric and Ben have received messages from hundreds of people including doctors and game designers. According to Ben, the most important people are the children who are in the position he was once in. For that reason he and Eric wanted to keep the game quite simple, so that even young children can play and understand it.
The player faces monsters representing the side effects of cancer. A fever monster throws fireballs, a giant, evil chicken represents chicken pox and a robot called Robarf hurls a green gooey mess - the sickness most children with cancer will face. While they can be battered by the monsters and have to use up some of their health to destroy the cancer cells, the player cannot be killed off in the game. Ben insisted on this, in order to send a clear message to other children. "I just want them to learn what the medicine is doing to their body and how it's helping it," he explained. "And I hope that they'll learn not to give up, to stick with it or you won't make any progress. And to just hang in there and have fun."
To play Ben's Game, go to www.makewish.org/ben where you can download the game, as well as read messages from Ben and find out more about the project.
A large UK study has failed to find strong evidence tying parents' on-the-job exposures to radiation and chemicals to their children's risk of cancer. Researchers did find, however, a slightly higher risk of leukemia among the children of men exposed to vehicle exhaust fumes at work--including drivers of buses, cabs and delivery trucks. The investigators say more research is needed to establish a cause-and-effect relationship, and, if there is one, to figure out the specific chemicals involved. The new findings are from the UK Childhood Cancer Study (UKCCS), which was set up more than a decade ago to investigate the causes of cancers such as leukemia and brain tumors in children. There has been concern that parents' occupational exposure to potentially cancer-causing substances around the time of conception or during pregnancy could promote cancer in their children. But studies have so far yielded conflicting results. The new findings, reported in the December issue of Occupational & Environmental Medicine, do not establish a link between childhood cancer and parents' exposure to radiation, chemicals such as pesticides, or other exposures such as electromagnetic fields.
"The findings of the UKCCS failed to produce any strong evidence to link exposures experienced by mothers or fathers during their work with an increased risk of childhood cancer," the investigators, led by Dr. Patricia A. McKinney of the University of Leeds, said in a statement. One exception was the link between fathers' on-the-job exposure to exhaust fumes around the time of conception and a "small increased risk" of childhood leukemia. "However," McKinney and her colleagues said, "the data do not allow the identification of any specific chemicals, and other explanations of the link cannot be ruled out." In their report, the researchers note that there's no known mechanism by which fathers' exposure to vehicle exhaust might promote leukemia in their children. It's possible, they speculate, that benzene, a chemical found in vehicle emissions, could damage sperm in a way that would promote leukemia in the father's children. High levels of benzene in the workplace have been tied a higher risk of leukemia among workers. But, McKinney and her colleagues point out, there's been no published research on the potential effects of a father's exposure to traffic pollution on the health of his children.
Nearly 90% of adult survivors of childhood cancer believe that, overall, they are in very good health, according to a recently published study - yet almost half of the group also reported having had at least one significant health problem develop since cancer treatment ended. Study authors urged the primary care doctor caring for an adult survivor of childhood cancer to watch for and promptly treat certain health issues common to these patients. "These findings help characterize the high-risk childhood cancer survivor who is more likely to require intervention to optimize long-term health outcomes, " wrote Melissa Hudson, MD, et al. in the Journal of the American Medical Association (Vol. 290, No.12: 1583-1643). About 270,000 childhood cancer survivors live in the US today, according the National Cancer Institute.
"The majority of survivors are resilient. They move on with life and adapt to chronic health problems if they occur," said lead author Melissa Hudson, MD, of St. Jude's Children's Research Hospital, in Memphis, Tenn. However, some survivors are more likely than others to develop significant physical or mental health problems, she found, depending on personal characteristics and the type of cancer they experienced. Health problems were more common among women survivors, among those with less than a high school education, and among those with a household income lower than $20,000. On the flip side, leukemia survivors were less likely to report a subsequent health problem than were survivors of other forms of cancer, such as bone cancer, central nervous system tumors, sarcomas, and Hodgkin disease.
For this study, 9,535 survivors, ages 18-48, completed a detailed questionnaire as part of the ongoing Childhood Cancer Survivor Study (CCCS). For comparison purposes, 2,916 siblings did the same, except that they didn't have to answer cancer-related questions. Hudson and colleagues specifically looked for answers that dealt with six aspects of health: general health, mental health, functional status, activity limitations, cancer-related pain, and cancer-related anxiety/fears. They found survivors more likely to report poor general health than siblings - 10.9% compared with 4.9% - and more likely to report mental health issues - 17.2% vs. 10.2%. Some degree of functional impairment - an inability to care for oneself and/or go to work or school - was reported by 12% of survivors and 2.5% of siblings.
Lingering cancer-related anxiety was significantly higher for survivors of Hodgkin disease, sarcomas, and bone cancer. One reason, Hudson suggests, is that these conditions are more common in teenagers than in children. The survivors, then, were old enough during treatment to fully understand they had a serious, life-threatening disease, knowledge that led to anxiety in some. Hodgkin disease survivors were more likely to report poor general health than any group except survivors of central nervous system cancers, such as brain tumors, who may have severe mental impairment. Yet the Hodgkin survivors had the least trouble functioning at work, school, or home. Schwartz noted that many Hodgkin disease survivors report fatigue, which could explain their perception of poor health. Hudson et al. suggest that lingering anxiety could play a role as well. "Maybe it's misinformation that causes the anxiety, or survivors may not have gotten a full explanation of what to expect for the future," said Hudson. "They don't know whether to be afraid or reassured." "One thing that helps is when a physician takes the time to fully explain the health risks a survivor may face," said Hudson.
To take control of their health and future, Hudson says survivors should request detailed reports on the therapy they received as children, including specific medicines. They should give copies to their current doctor, or better yet, a cancer survivor's follow-up clinic. The reports become doubly important as the CCSS and other studies produce new information about which treatments might be linked to delayed or hidden health problems. Such information can save lives, according to Schwartz, who directs a program at Johns Hopkins Medical Center that sends health updates to patients who've grown up and changed doctors. "We had one woman who, within a week of receiving our newsletter, was getting a heart bypass," Schwartz recalled. The woman had complained of chest pains to her doctor in Washington State, but was told she was too young to have heart problems -- until her doctor read the survivor newsletter?. "We're not done taking care of them when the treatment is over," she said.
So why do most childhood cancer survivors report being in good overall health - even if they have experienced significant health problems? It "may reflect an enhanced appreciation of life after therapy, despite adverse effects on actual health status," Schwartz wrote in the editorial. "It may be related to a belief in a higher power, some greater insight or emotional maturity caused by the cancer experience," suggested Hudson. "The article tells us that overall life is good, survival is worth it, and they have many, many years of good life ahead of them,| said Schwartz. "We can say there are 9,000 young adult survivors in this study and most have normal lives: They marry, have children, and hold down jobs. That's what you can expect."
Scientists at the Children's Cancer Institute in Australia have made a discovery that could improve the survival rates of hundreds of children suffering from cancer. The researchers have identified a compound that allows resistant cancer cells in children with neuroblastoma to be destroyed with chemotherapy. Associate Professor Murray Norris said the study showed that cancer patients responded poorly to chemotherapy due to high levels of a gene called MRP1 in their tumour cells. MRP1 acts like a vacuum cleaner inside cancer cells by preventing chemotherapy drugs from getting in and destroying them and effectively protecting the rogue cells.
Researchers said that the new compound, tentatively named 4H10, made the cancer cells sensitive to chemotherapy again by blocking the action of the MRP1 gene. "This study is a significant one. This gene is one of the major factors contributing to these children doing so poorly," news.com quoted Norris as saying. However, another associate Professor David Ashley, from the Royal Children's Hospital said that he was concerned the research had not yet been subjected to peer review. "The strongest I think you can say is that it could be potentially helpful," added Ashley.
According to new research, the month you were born in could affect your chances of developing brain cancer later in life. After studying data on adults with and without brain cancer, the researchers found that people born in January and February had the highest risk while those born in July or August had the lowest. The link was even stronger with left-handed or ambidextrous people born in the winter (northern hemisphere). Lead researcher Dr. Alina Brenner, National Cancer Institute, Bethesda, Maryland, USA, said it is too early to be sure of this link – all could be just due to chance.
Scientists know little about the early causes of brain tumors. The scientists in this study wanted to find out if there were any new clues. If the association between birth month and brain cancer risk is real, and this could be confirmed by a new ongoing study, then researchers could look into the reason why. The researchers said factors such as infections, maternal diet, environmental toxins and hormone influences (during pregnancy) could be playing a part. We have no idea whether any of these factors is playing a part, they say. We don’t even know when, during the pregnancy, these factors may be more critical.
The scientists studied 686 patients with brain cancer and 799 people who had been hospitalized for other conditions (they did not have brain cancer). The patients came from three different hospitals in the USA. They found that winter babies were at higher risk of developing brain cancer, diseases affecting the nervous system, epilepsy, schizophrenia.
Women who take vitamin and mineral pills before and during pregnancy may reduce the risk that their baby will develop a cancer of the nervous system called neuroblastoma, according to researchers. Neuroblastomas are highly malignant tumors that arise in nervous system tissue and are usually diagnosed in infants or young children. The tumors spread rapidly to the lymph nodes, liver, lung and bone."In the United States, neuroblastoma has an incidence of 9.1 per million children under the age of 15 years and is the most common tumor in infants," Andrew F. Olshan of the Children's Oncology Group in Arcadia, California, and colleagues note in their report.Many studies have shown that regular vitamin use by moms-to-be can reduce the risk of birth defects such as spina bifida and cleft palate.
One previous study also suggested that women who use vitamins while pregnant may reduce their child's risk of developing neuroblastoma. To investigate, Olshan and colleagues interviewed 538 women, each with a child who developed neuroblastoma before the age of 19, about their vitamin and mineral use. The women were compared with 504 mothers whose children did not have the disease.
"Daily vitamin and mineral use in the month before pregnancy and in each trimester was associated with a 30% to 40% reduction in the risk of neuroblastoma," the authors write in the September issue of the journal Epidemiology. "We were unable to isolate the effects of specific vitamins or minerals," they add. The researchers are calling for more research on the relationship between a pregnant woman's vitamin use and her child's neuroblastoma risk.
Italian surgeons who reconstructed a young cancer patient's hip by using a combination of the patient's thighbone and a donor bone graft report the new joint is still doing well more than four years later. Writing in a research letter in tomorrow's issue of The Lancet, Dr. Marco Manfrini from the Rizzoli Orthopaedic Institute in Bologna and his colleagues describe the procedure that was done. The girl was 4 years old when she came to their attention in mid-1997 with a diagnosis of Ewing's sarcoma, a bone tumor. The cancer extended from the upper part of her femur, or thighbone, which makes up the "ball" part of the hip's "ball and socket" anatomy, to the middle of her thighbone. Today, the girl has full hip mobility and can attend school, ride an exercise bike, swim and walk without canes at home. She also has no discrepancies in limb lengths.While surgeons have previously reconstructed other skeletal segments lost to cancer, the Italian authors note that "no limb-salvage techniques have been described for hip reconstruction in this age group."
Ewing's tumor, also called Ewing's sarcoma, most often occurs in children and adolescents between the ages of 10 and 20. Bone tumors, the growth of abnormal cells in the bones, can be cancerous or not; Ewing's is cancerous. It most often develops in the arms or legs but can occur in any bone. Symptoms include pain and swelling. Treatment typically involves a combination of surgery, radiation and chemotherapy, with amputation or reconstruction also done. About 60 percent are cured.
Manfrini and his team first removed some of the girl's cancerous thighbone and then transplanted her calf bone, keeping the blood supply intact, to create a new thigh bone. This transplant was inserted into a large piece of donor thighbone that was cut and shaped to fit. The new construction was held in place with small screws and a long titanium plate. Main muscles were all reattached to the newly fashioned joint. After four months, the girl exercised on a stationary bike, and by nine months she had active movement of the hip. At the time of the report, four years and five months after the reconstruction, the girl is disease-free, the authors note. The graft grew lengthwise and cross-sectionally. The head of the thighbone also grew. The researchers did a medical literature search and did not find any reports of the type of reconstruction they did in large joints of the lower limb.
The report is called "fascinating" by a medical oncologist familiar with the problem of Ewing's sarcoma. "It's a remarkable kind of treatment," says Dr. Herman Kattlove, a medical oncologist and medical editor for the American Cancer Society. "What they did is almost miraculous. They had to keep the blood supply intact. The surgeons must be very skilled." However, he adds a caveat: "We need to wait and see how it all turns out. I suspect she will need a hip replacement when she becomes full size. But still, she has a functioning leg for now and that is a plus." And hip replacement surgery, these days, is routinely done, he says.