Cancer treatments got gentler, yet kids' survival improved

CHICAGO -- The move to make cancer treatments gentler for children has paid a double dividend: More young patients are surviving than ever before, and without the long-term complications that doomed many of their peers a generation ago, new research shows.

Radiation and chemotherapy have saved countless children from cancer, but some of these treatments can damage the heart or other organs -- problems that prove fatal years later.

In the 1990s, a push began to try to prevent these "late effects" by giving smaller, more targeted doses of radiation, avoiding certain drugs and changing the way chemotherapy is given. But doctors worried: Would gentler treatments hurt a child's survival odds?

The new study, which tracked more than 34,000 childhood cancer survivors over several decades, gives a happy answer: no.

Survival continued to improve, even with scaled-back treatments, and fewer children died from second cancers or heart or lung problems 15 years after their initial treatment ended.

Gatlin Stringer, 14, left, and his brother, Garrett, 20, visit Houston's M.D. Anderson Cancer Center on May 22. (Pat Sullivan ~ Associated Press)

"The field needs good news," and this study gives it, said Dr. Greg Armstrong of St. Jude Children's Research Hospital in Memphis, Tennessee. He leads the Childhood Cancer Survivor Study, funded by the National Cancer Institute.

"We have actually reduced treatment, reduced therapy," yet improved survival, he said.

Results were discussed Sunday at an American Society of Clinical Oncology conference in Chicago.

Treating childhood cancer is "one of the miracles of modern medicine," Armstrong said. "Fifty years ago, less than 30 percent of kids would survive childhood cancer, but now we know that over 80 percent will."

The high success rate allowed doctors in the 1990s to scale back certain treatments for certain types of patients to try to spare them late effects. The study compared survival odds before and after that change.

Researchers found the death rate 15 years after treatment ended kept declining, from about 12 percent for those treated from 1970 to 1974 to 6 percent for those treated from 1990 to 1994. Deaths from late effects of cancer treatment, such as heart problems, also declined over that period, from 3.5 percent to 2.1 percent.

Garrett and Gatlin Stringer, brothers from Huntsville, Texas, benefited from the change, said their physician, Dr. Michael Rytting at M.D. Anderson Cancer Center in Houston.

The boys had acute lymphocytic leukemia, the most common childhood cancer.

When doctors described their treatment, "we didn't really ask long-term effects, to be honest, because at the time it was really just kind of day-to-day," said their mother, Marsha Stringer.

Garrett, 20, was diagnosed at age 7 and is a 13-year survivor. Gatlin, 14, was diagnosed at age 3 and is 11 years past his treatment.

The boys got chemotherapy, but because scans showed the disease had not spread to their spinal cords, they were spared radiation.

Now, they are "amazing ... no side effects at all that we know of," their mother said. "They're very athletic and active and have good grades."