Cancer treatment in children is almost always long-term (months to years), has many side effects, and is a great burden on the family. Without comprehensive supportive care, today's cancer treatment would not be possible to complete.
Pediatricians in Norway participate in Nordic and international collaborations, as well as clinical treatment studies with Nordic and international protocols.
Treatment of cancer in children includes chemotherapy, surgery, and sometimes radiation therapy. Most cancer forms are aggressive, and in general, these cancer forms are more sensitive to chemotherapy than slow-growing tumors. Chemotherapy therefore has a greater presence in treating childhood cancer than adult cancer.
Chemotherapy is the treatment form for leukemia, and is sometimes supplemented with radiation therapy of the central nervous system. A stem cell transplantation is sometimes performed.
Most tumors outside the central nervous system are treated with preoperative chemotherapy, surgery, and postoperative chemotherapy. Preoperative chemotherapy will, in most cases, reduce the size of the tumor making it easier to remove thereby reducing the extent of surgery. Radiation therapy may be included in the treatment plan for these tumors. Only a minority of tumors are treated with surgery alone.
Brain tumors are treated by surgical resection, both to obtain a tissue sample for histological examination and to remove as much as possible of the tumor. In the majority of children with brain tumors, surgery is the only treatment, and the patient is monitored regularly with MRI to detect recurrence. In about 1/3 of patients, the tumor is malignant and additional treatment with chemotherapy and/or radiation therapy is necessary to improve the result. Postoperative treatment with chemotherapy and radiation therapy of a typical, yet malignant tumor of childhood (medulloblastoma), has produced a dramatic improvement in survival.
In some cases, radiation therapy is used either as a supplement to chemotherapy and surgery, or as primary local treatment if the tumor is inoperable. Small children who are not able to lie still for treatment must be under general anesthesia to complete treatment. This may mean the child must be put under general anesthesia up to thirty times.
Even though radiation therapy poses a risk for delayed injury, it is an important element to improve chances of long-term survival of cancers such as medulloblastoma, manifest CNS leukemias, and intracranial germinomas. With radiation therapy, it is possible to cure other childhood malignant conditions (Hodgkin's lymphoma, sarcoma, advanced stages of Wilms' tumor and neuroblastoma, as well as localized carcinoma or other localized tumors) particularly if local treatment is not possible in the form of surgery.
Radiation therapy is an effective local treatment for cancer. However, healthy tissue surrounding the tumor tolerates only a limited amount of radiation before the child develops a risk for delayed injury. From high doses of radiation, delayed damage may be severe.
All radiation therapy in children is a difficult balance between the risk of dying from cancer and the risk of developing permanent damage after life-saving treatment. A risk assessment of this nature raises ethical questions for parents and doctors: what extent of injury is acceptable before the price of survival is too high? Guidelines given in international treatment protocols for radiation therapy of childhood cancer are a good source for support in these difficult situations.
Very severe cognitive damage must be expected following high doses of radiation to large parts of the brain in children younger than 3 years. Therefore, radiation therapy to the brain is avoided if at all possible in this patient group. Intense chemotherapy poses less risk for delayed damage and can replace radiation treatment for brain tumors, in very young children, in some cases.