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Stanford Cancer Institute
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Pediatric Oncology Services

Introduction

Lucile Packard Children's Hospital at Stanford (LPCH) is a tertiary care referral center and community hospital devoted exclusively to the care of children and expectant mothers. The hospital opened in 1991 adjoining the east wing of Stanford University Hospital on the Stanford campus in Palo Alto, California and is now ranked as one of the nation's top ten pediatric hospitals by U.S. News & World Report. Packard Children's offers patients locally, regionally, and nationally a full range of health-care programs and services-from preventive and routine care to the diagnosis and treatment of serious illness and injury. Associated with Stanford School of Medicine, LPCH provides pediatric and obstetric medical and surgical services, including Pediatric Intensive Care, Hematology/Oncology, Pediatric Surgery, and Pediatric Transplant Surgery.

The pediatric oncology program at Lucile Packard Children's Hospital is renowned for delivery of comprehensive, multidisciplinary care to children and adolescents with cancer. Pediatric oncologists incorporate the expertise of multiple specialists such as pediatric surgeons, pediatric radiation therapists, pediatric rehabilitation, pediatric radiologists, child play therapists, school liaisons, and nurse practitioners. This multidisciplinary team is dedicated to providing comprehensive physical and psychosocial care to families learning about and living with the illness.

The pediatric oncology faculty is highly trained in translational and laboratory research as well as state-of-the-art clinical care, and is internationally renowned for helping to promote advances in the understanding and treatment of childhood cancer. Diagnostic evaluation and therapeutic management plans for children with malignant diseases include but are not limited to the following conditions:

• Brain Tumors

• Ewing's Sarcoma

• Germ Cell Tumors

• Hodgkin's Disease

• Leukemia

• Liver Tumors

• Neuroblastoma

• Non-Hodgkin's Lymphoma

• Osteosarcoma

• Rhabdomyosarcoma

• Wilms' Tumor

General Information

Clinical and Research Information

Research Efforts

Examples of studies in progress are:

• to determine whether new drugs will improve survival in children with osteosarcoma

• to find novel ways to treat children with brain tumors

• to optimize outcomes for children requiring bone marrow transplantation

• to investigate possible environmental causes of childhood cancer

• to learn more about the psychosocial impact of childhood cancer on the family and the best way to provide support for cancer survivors

• to investigate mechanisms that allow cancer cells to escape killing by chemotherapy drugs and mechanisms of cancer cell growth to find new approaches to interrupting this cycle

Special Expertise

Brain Tumors

A multidisciplinary team of experts in Neuro-Oncology, Neurosurgery, Radiotherapy, and Neuroradiology have established a nationally recognized program for children with brain tumors. These physician scientists are key investigators for innovative therapeutic studies from the Children's Oncology Group, Pediatric Brain Tumor Consortium, and other regional groups. At Lucile Packard Children's Hospital, this physician team meets weekly for the region's only pediatric-dedicated Neuro-Oncology Tumor Board. The service's Neuro-Oncology clinic provides comprehensive care to address physical, educational, social, and emotional needs of children affected by brain tumors and their therapies.

Hodgkin's Disease

Investigators at Stanford are recognized internationally as experts in the treatment of Hodgkin's disease. Management of children with low-dose radiation combined with chemotherapy was pioneered at Stanford and has become the standard around the world. Innovative new therapies designed to minimize toxicity for children with favorable prognosis and intensifying therapy for those with less favorable clinical features are the focus of current studies.

Late Effects/Long-Term Survivorship

The pediatric group at Stanford/LPCH is part of a national study of 25,000 survivors of childhood cancer and places special emphasis on the assessment of cardiac, pulmonary, and neurocognitive late effects.

Leukemia

Investigators at Stanford are leaders in dissecting the immunology of acute lymphoblastic leukemia and in discerning the molecular events that underlie leukemogenesis. Researchers are nationally recognized for studies directed at reversing multi-drug resistance in leukemia and applying these findings to the treatment of children with refractory leukemia and those with newly diagnosed acute non-lymphocytic leukemia.

Non-Hodgkin's Lymphoma (NHL)

Investigators from Stanford are internationally recognized experts in the management of non-Hodgkin's lymphomas in children. Stanford faculty have played a key role in the development of cooperative group protocols for children with NHL and have coordinated efforts in early stage NHL for the past 15 years.

Resistant Cancers and New Agents

Stanford has an NIH-funded pediatric clinical research center that is dedicated, in part, to testing new therapies for children with advanced refractory cancer. Novel anti-cancer agents including monoclonal antibodies or immunotoxins specifically directed against leukemias, differentiating agents to induce tumor growth arrest, targeted radiotherapy, and other new cancer chemotherapeutic drugs are administered to children with refractory cancer. In addition, important laboratory/clinical efforts directed at elucidating and overcoming mechanisms of drug resistance is an important part of the Pediatric Oncology program.

Sarcomas of Bone and Soft Tissue

Physicians at Stanford have established multidisciplinary programs in sarcomas of bone and soft tissue led by international experts in Pediatric Oncology, Radiation Oncology, Orthopedic Oncology, and Pathology. There is a strong commitment for optimal individualized tumor management with preservation of maximum function. Investigators from Stanford have had major leadership roles in important trials in malignant bone tumors, demonstrating the role of adjuvant chemotherapy in the treatment of osteosarcoma, the safety of reducing the volume of radiotherapy in treating Ewing's sarcoma, and the efficacy of intensified regimens for the treatment of Ewing's sarcoma and osteosarcoma.

Investigators from Stanford have played leading roles in the Intergroup Rhabdomyosarcoma Study Group (IRSG) and have major input in the design of biologic and therapeutic studies for children with Rhabdomyosarcoma. Studies of the IRSG enroll almost all children with Rhabdomyosarcoma in the United States and Canada.

Stem Cell Transplantation

Stanford has a very active pediatric stem cell transplantation program specializing in transplants for hematologic malignancies, solid tumors, and genetic disorders. The program provides transplants using a variety of stem cell sources including autologous, purged autologous with tumor cell removal, unpurged peripheral blood stem cells, autologous transplants including both bone marrow and peripheral blood stem cells from related and unrelated donors, partial mismatches with stem cell manipulation, and cord blood transplants.

Diseases treated include malignancies such as acute or chronic leukemia, Hodgkin's or non-Hodgkin's lymphoma, and selected pediatric solid tumors such as neuroblastoma and rhabdomyosarcoma.

Lucile Packard Children's Hospital is a designated CCS Bone Marrow Transplant Center and Center of Excellence. The pediatric BMT service is an approved transplant center for Children's Oncology Group protocols.

Statistics

Percent of children treated in each age range

Pediatric Oncology Program, 2005

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