Major advances have been made in the understanding and management of the malignant diseases of childhood. More than 50% of children with cancer can now be expected to survive five or more years; a few decades ago, most of these patients died within 1 year. These good results have been obtained through the use of combined-modality therapy; that is, the conjoined use of surgery, radiation therapy, and multiple-agent chemotherapy. Wilms' tumor provides a spectacular example (Fig 1). Although achieving higher cure rates, combined-modality treatment is often rigorous, and has its associated early and late complications. The goals of modern pediatric oncology reflect both of these facts. Higher cure rates continue to be sought, but there is a growing recognition that not all patients need maximum treatment. Therapy can now be modulated according to well-defined prognostic factors for most of the malignant conditions. In that way, the most aggressive therapies are reserved for those at highest risk, while those with a good prognosis can be managed less intensively. The objectives of modern management, then, are to cure most patients while at the same time minimizing, as much as possible, the associated deleterious late consequences of successful treatment.
wilms' tumor and neuroblastoma serve as good examples to demonstrate the above points.
Multiple Agent Roles in an Adaptive Virtual Classroom Environment
