title: Risk-based management of solid tumors in children.
abstract: BACKGROUND
  During the past 25 years significant improvements in survival (56% to 75%) have been observed for children with malignant solid tumors. Multidisciplinary cooperative studies using combined therapy (surgery, chemotherapy, and irradiation) have played a major role. This report describes how recognition of biologic and genetic factors has permitted risk categorization and resulted in new treatment protocols that individualize care.
  
  
  METHODS
  Genetic alterations and biologic factors concerning the multiple endocrine neoplasia syndromes, Wilms' tumor, and neuroblastoma are described.
  
  
  RESULTS
  Using the these data new treatment protocols are designed according to whether a patient is categorized as having a low-, intermediate-, or high-risk tumor, which determines the intensity and type of treatment required.
  
  
  CONCLUSIONS
  Identification of biologic markers and specific gene alterations may be critical in establishing the behavior of tumors (low versus high-risk). Risk-based management permits individualized care for each patient, maximizes survival, minimizes morbidity, and improves the quality of life.
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, Indiana University School of Medicine and the J. W. Riley Hospital for Children, Indianapolis, Indiana 46202, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Grosfeld
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000235:genetics / Q000601:surgery / Q000628:therapy; D000313:Adrenal Medulla; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007680:Kidney Neoplasms / Q000235:genetics / Q000601:surgery / Q000628:therapy; D009377:Multiple Endocrine Neoplasia / Q000235:genetics / Q000601:surgery / Q000628:therapy; D009369:Neoplasms / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D009447:Neuroblastoma / Q000235:genetics / Q000601:surgery / Q000628:therapy; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D009396:Wilms Tumor / Q000235:genetics / Q000601:surgery / Q000628:therapy