Survival of children with cancer in Torino, Italy

Trends in Childhood Cancer Mortality in Italy, 1955-78

Trends in childhood cancer death rates in Italy from 1955 to 1978 were analyzed. All cancer age-standardized mortality below age 15 fell about 20%, with a clear downward trend since the early 1970's. Declines were evident for leukemias (–25%), Hodgkin's disease (–56%), non-Hodgkin's lymphomas (–27%), kidney cancer (–25%), retinoblastoma (–50%), and bone sarcomas (–31%), for a total number of about 200-250 fewer deaths per year in the late 1970's compared to the expected values using rates of the 1950's. The observed fall was apparently confined within the first age group considered (0-4 years), but the age-specific patterns of trend were partly influenced by simple postponement of some deaths to older age groups. Comparisons with similar data in other developed countries suggest that, although there has undoubtedly been some progress, there is still wide scope for further reduction in childhood cancer mortality in Italy, simply through more rational use of currently available diagnostic and therapeutic knowledge.

Late deaths and second primary malignancies among long-term survivors of childhood cancer: an Italian multicentre study

A multicentre registry of children who had been successfully removed from therapy for some common childhood cancers (Hodgkin's disease, non-Hodgkin's lymphoma, neuroblastoma, nephroblastoma, acute lymphatic leukaemia and other leukaemias) was established in Italy in 1981. The present study describes mortality and occurrence of second primary malignancies (SPMs) among 1467 children who were alive when the registry was established. Follow-up ended on December 31, 1983 for mortality and 1 year later for the occurrence of SPMs. Sixty-seven deaths were recorded, 11 of which were due to causes other than progression of the original disease. Eleven incident SPMs were identified (i.e. 3 acute myeloid leukaemias, 3 thyroid carcinomas, 1 bilateral breast carcinoma, 1 liver malignant mesenchymoma, 1 astrocytoma, 1 chondrosarcoma and 1 osteosarcoma) corresponding to an incidence rate of 2.1/1000 patient-years at risk. Anecdotal reports were collected regarding 2 further SPMs (a thyroid carcinoma and a myeloid leukaemia) as well as several benign tumours, including 2 mammary fibroadenomas.

Prognostic factors in neuroblastomas treated in Denmark from 1943 to 1980. A statistical estimate of prognosis based on 253 cases

Multivariate analysis on an unselected patient population consisting of all 253 children treated for neuroblastoma in Denmark during 1943 to 1980 shows that stage, age, and treatment given are independent prognostic variables. Calendar year of diagnosis, sex of the patient, and site of primary tumor were not significant prognostic factors. Further analysis shows that multimodal treatment with surgery, irradiation, and chemotherapy, especially in patients older than 1 year of age with Stage II disease, has influenced the survival significantly. The fact that age at diagnosis and the administration of chemotherapy have independent prognostic significance can be explained by the theory that all neuroblastomas are virtually congenital; therefore, the difference in age at diagnosis largely reflects the difference in growth rates of the tumor. Thus, according to this theory, age may be a measure of the probability of micrometastases in addition to the clinical extent or stage of the disease, as it represents the duration of the disease. Additional chemotherapy may thus have eradicated these micrometastases in the older children, since the age influence on Stage II disease disappeared when multimodal treatment was given in this study. The implications for treatment policy are discussed in view of this theory.

Childhood Cancer Registry of the Province of Torino: survival patterns since 1967 and update of incidence rates

During 1967-1981, the population-based Childhood (ages 0-14 years) Cancer Registry of the Province of Torino has recorded 1057 resident children with incident cancer. The life status of each child has been ascertained as of December 31, 1983. Sex- and age-specific incidence rates have been stable throughout the period. Annual mortality rates (per million) from leukemias (all types) decreased from 34.0 in 1967-69 to 19.4 in 1979-81. Correspondingly, the survival percentage cumulative of leukemic children at 3 years after diagnosis increased from 16 for children diagnosed in 1967-69 to 57 for those diagnosed in 1979-81. For other cancer types, no increases or debatable decreases in mortality rates and increases in survival rates were recognized.

Neuroblastomas treated at the four major child oncologic clinics in Denmark 1943-1980: an evaluation of 180 cases

One hundred and eighty cases of neuroblastomas from the four child oncology clinics are reviewed. The overall cure rate was 24%. During the 38-year period, there was a significant increase in survival from 0% during the period of 1943-1950 to 32% during the period of 1971-1980. This improved survival rate is most likely a result of adjuvant chemotherapy. Forty percent of the patients appear chronically ill, which reflects the fact that nearly 60% have metastases when they are first seen. In localized disease (stages I-II), the prognosis was favourable (cure rate 69%), while the prognosis for disseminated disease (stage III-IV) was poor (cure rate 5%). A favourable outcome was seen in patients under 1 year (survival rate 46%), and in patients with primary tumours located in the neck or mediastinum (survival rate 48%). When related to stage, however, the survival rates for the former tumours were not significantly better in patients below 1 year or in patients with cervical or thoracic tumours. As is the case in other studies, we found that survival is significantly poorer in males.