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C A Stiller

Publications and source records attributed to C A Stiller.

At least 73 records · Page 4Linked to original sources
PubMed1993

Trends in neuroblastoma in Great Britain: incidence and mortality, 1971-1990.

Incidence and mortality rates for neuroblastoma in Britain from 1971 onwards were examined using data from the population-based National Registry of Childhood Tumours. Incidence throughout 1971-1990 was within the range previously reported from Europe, North America and Oceania. The age-standardised rate rose, however, by 26% between 1971-1975 and 1986-1990, and there were increases of 36% both among infants aged under one year and also among children aged 1-9. There was a pattern of increasing risk with more recent years of birth up to 1985. It is implausible that improved diagnosis could explain the increase in rates since 1971, though it may account for a marked decrease in recorded incidence at the age of 10-14. Age-standardised mortality fell by 27% between 1971-1975 and 1981-1985, but rose again during 1986-1990. This was the result of a halt in the improvement in survival rates for neuroblastoma combined with a substantial and as yet unexplained increase in incidence.

Adolescent↗
PubMed1993

Congenital abnormalities in children with cancer and their relatives: results from a case-control study (IRESCC).

Several studies have revealed an excess of malformations in children with certain malignancies. A few environmental causes have been identified which may damage the foetus and lead to malformation and cancer. However, most of the numerous recognised cancer/malformation syndromes are genetically determined. This report describes a case-control study of 555 newly diagnosed children with cancer and 1,110 matched controls, chosen from general practitioner lists (GP controls) and hospital admissions (H controls). Their parents were interviewed on topics of possible aetiological significance and medical records were checked to confirm reports at interview. The numbers of congenital malformations in the index and GP control children, and the relatives of the index children, the GP and H controls are described. There were more children with malformations among the cases (60/555) than among the GP controls (27/555), P < 0.001. The abnormalities in the cases included eight with specific chromosomal/genetic conditions (e.g. Down's syndrome, XY gonadal dysgenesis, Von Recklinghausen's neurofibromatosis, Goldenhar's syndrome) whereas only one GP control child had a chromosomal defect (P < 0.05). Five case children but no GP controls had neural tube defects; this is not statistically significant. No excess of malformations was found in the siblings of cases compared with GP and H control siblings. Case mothers had a small excess of malformations (22/555) compared with GP controls (8/555), P < 0.05. Among more distant relatives the results were difficult to interpret because of the relatively small numbers in the diagnostic subgroups and because of apparent under reporting in grandparents, but no striking differences were seen between case and control relatives. The excess of malformations found in children with cancer, compared with controls, without a similar excess of malformations in their close relatives may indicate that in some (perhaps very roughly one in 20) cases antenatal events may lead both to the malformation and the malignancy.

Case-Control Studies↗
PubMed1993

An audit of the activities of the paediatric oncology unit in Edinburgh, 1982-1991.

The activities of the paediatric oncology unit at the Royal Hospital for Sick Children, Edinburgh during 1982-1991 were audited. There were 254 new patients of whom 240 had a malignancy, seven had Langerhans cell histiocytosis and seven had non malignant tumours. Of the 254,131 (52%), 78 (31%), 14 (65), were normally resident within the Lothian, Fife and Borders regions respectively. Therefore, although the unit is a part of the Lothian Health Board, it is in practice, the referral centre for S.E. Scotland. A majority (92%) of patients were treated according to national or international protocols during the last five years and of the 240 children diagnosed to have cancer, 158 (66%) are at present in clinical remission. These figures compare favourably with national averages for protocol compliance and survival. During these ten years, an additional 69 children with cancer from S.E. Scotland were treated at other centres. Therefore, while the unit justifies its existence it has yet to realise its full potential.

Adolescent↗
PubMed1992

International variations in the incidence of neuroblastoma.

The International Agency for Research on Cancer has coordinated a worldwide study of childhood cancer incidence, with data from over 50 countries. We present here the results for neuroblastoma. In predominantly white Caucasian populations the age-standardized rate was 7-12 per million, and 6-10% of all childhood cancers were neuroblastomas. Rates were highest in the first year of life (25-50 per million, 30% of total neuroblastoma incidence), and decreased with age to 15-20 per million (50% of the total) at age 1-4, 2-4 per million (15%) at 5-9 and 1-1.5 per million (5%) at 10-14. In the United States, black children had an incidence of 8.5 per million compared with 11.5 among Whites; Blacks tended to be older than Whites at diagnosis. The highest rate in Africa was in Bulawayo, Zimbabwe (8.0 per million) and the lowest in West Nile, Uganda, with no cases registered. Incidence in Israel was similar to that in many white populations, with Jews having a particularly high rate. In other parts of West Asia neuroblastoma had a low relative frequency, suggesting that incidence is low. Rates were also low throughout much of southern and eastern Asia, including India and China. Incidence in Japan was somewhat higher, though less than in Western countries, with the deficit most pronounced in the first year of life; these data relate to the period before mass screening of infants for neuroblastoma in the regions concerned. Incidence was generally higher in regions and among ethnic groups enjoying a higher standard of living, though previous studies within single countries had suggested that neuroblastoma is more common among less affluent groups. Blacks in Africa and the United States may have a weaker genetic predisposition to neuroblastoma, but some of the deficit in many developing countries is likely to be due to under-diagnosis.

Adolescent↗
PubMed1992

Causes of death in children diagnosed with non-Hodgkin's lymphoma between 1974 and 1985.

An investigation has been undertaken of 479 deaths occurring up to the end of 1990 among 883 patients diagnosed with non-Hodgkin's lymphoma from 1974 to 1985 who were included in the population based National Registry of Childhood Tumours. The objectives were to perform a descriptive analysis looking particularly at the deaths not directly due to non-Hodgkin's lymphoma, to determine the frequency of the different causes of death and to study the trends over time. Among the 476 patients with sufficient information for the cause of death to be established, these were: non-Hodgkin's lymphoma, 377 (79%); treatment related (other than second primary tumour), 86 (18%); second primary tumour, 10 (2%); and other, three (1%). The proportion of all deaths not directly due to non-Hodgkin's lymphoma increased from 15% for those diagnosed during 1974-6 to 32% for those diagnosed during 1983-5. Among the 86 treatment related deaths, the more precise causes were bacterial infections, 26 (30%); viral and other infection, 14 (16%); metabolic, 19 (22%); renal, eight (9%); anaesthetic related, seven (8%); respiratory, four (5%); cardiac, three (3%); graft versus host disease, three (3%); and other, two (2%). Treatment related deaths from infection accounted for 27 (6%) of all patients diagnosed in 1974-9, and 13 (3%) in 1980-5. Treatment related deaths not due to infection occurred in 23 (5%) of those diagnosed in 1974-9 and 23 (6%) in 1980-5. Five treatment related deaths, including four anaesthetic related deaths, were identified as avoidable. Some of the deaths from metabolic and renal disease may also have been avoidable. Only 11 deaths have been recorded more than five years after diagnosis, six being due to second primary tumours. As follow up is relatively short for patients diagnosed more recently, further deaths from second malignancies and treatment related cardiovascular problems may well occur. A substantial number of children with non-Hodgkin's lymphoma die to treatment related causes. Deaths from infection have decreased in line with the overall improvement in survival rates. Other treatment related mortality has remained constant. Further improvements in survival for childhood non-Hodgkin's lymphoma will depend on maintaining the fine balance between the therapeutic value of intensive treatment and its potential harmful effects.

Adolescent↗
PubMed1992

Brain and spinal tumours in children aged under two years: incidence and survival in Britain, 1971-85.

There were 548 children aged under two with brain and spinal tumours diagnosed during 1971-85 in Great Britain and included in the population-based National Registry of Childhood Tumours. Children aged under two accounted for 12% of all children registered with tumours in these sites. The annual incidence was 25.0 per million. Ependymoma, astrocytoma and medulloblastoma (including primitive neuroectodermal tumour) each accounted for around a quarter of the total. Five-year survival rates were 20% for ependymoma, 43% for astrocytoma and 13% for medulloblastoma, each significantly lower than for children aged 2-14 in the corresponding diagnostic group. Mortality in the first year after diagnosis was very high but there were also substantial numbers of later deaths. There was no significant trend in survival rates during the period under review.

Adolescent↗
PubMed1991

Childhood cancer and ethnic group in Britain: a United Kingdom children's Cancer Study Group (UKCCSG) study.

We present here the results of the largest study of childhood cancer and ethnic group in Britain, based on 7,658 children treated at paediatric oncology centres throughout the country. Incidence rates could not be calculated and so relative frequencies were analysed by the log-linear modelling method of Kaldor et al. (1990) with allowance made for regional variations in the ages and diagnostic groups of the children included in the study. Children of Asian (Indian sub-continent) and West Indian ethnic origin had similar patterns of incidence for acute lymphoblastic leukaemia to White Caucasians. There was a significant excess of Hodgkin's disease among Asian children compared with Caucasians with an estimated relative risk (RR) of 2.09; this excess was greatest in the 0-4 age group (RR = 6.67). There were significant deficits of Wilms' tumour and rhabdomyosarcoma among Asian children, each with a frequency around half that among Caucasians, whereas West Indians had a significant excess of Wilms' tumour (RR = 2.55). Asian and West Indian children each had a non-significant twofold RR for unilateral retinoblastoma. The results suggest that the incidence of childhood acute lymphoblastic leukaemia is associated with environmental determinants in the country of residence which are most likely to relate to lifestyle factors. The occurrence of retinoblastoma, Wilms' tumour and Hodgkin's disease in early childhood is apparently related more to ethnicity than to geographical location and may reflect genetic factors or environmental exposures specific to the lifestyle of particular ethnic groups.

Central Nervous System Neoplasms↗
PubMed1991

Contacts between adults as evidence for an infective origin of childhood leukaemia: an explanation for the excess near nuclear establishments in west Berkshire?

The increasing tendency for people to work outside their home community--one of the most striking of modern demographic changes--has relevance to a recent aetiological hypothesis about childhood leukaemia: that a community's immune response to an underlying infection can be disturbed by increases in new social contacts. This was tested in the only 28 former county boroughs in which accurate comparisons of workplace data from the 1971 and 1981 censuses are possible--because their boundaries were left unaltered by the major reorganisation in 1974. After ranking the districts according to extent of commuting increase, a significant trend in leukaemia incidence was found at ages 0-14 (P less than 0.05) and a suggestive one at ages 0-4 (P = 0.055). Among ten similar sized groups of county districts ranked by commuting increase, the only significant increases (P less than 0.001) of leukaemia in 1972-85 at ages 0-4 and 0-14 were in the highest tenth for commuting increase. These excesses persisted after excluding Reading, a major part of an area where an excess of leukaemia has been linked to the nearby nuclear establishments at Aldermaston and Burghfield. This whole area has experienced greater commuting increases than 90% of county districts in England and Wales. The findings are consistent with other evidence supporting the above hypothesis; they also suggest that contacts between adults may influence the incidence of leukaemia in children.

Adolescent↗
PubMed1990

Trends in survival for childhood cancer in Britain diagnosed 1971-85.

Survival rates were analysed for a population-based series of over 15,000 childhood cancers registered in Great Britain during 1971-85. There were highly significant improvements (P less than 0.001 for trend) in survival for many major diagnostic groups. Between 1971-73 and 1983-85 the actuarial 5-year survival rates increased from 37% to 70% for acute lymphoblastic leukaemia, from 4% to 26% for acute non-lymphoblastic leukaemia, from 76% to 88% for Hodgkin's disease, from 22% to 70% for non-Hodgkin's lymphoma, from 61% to 72% for astrocytoma, from 24% to 42% for medulloblastoma, from 15% to 43% for neuroblastoma, from 58% to 79% for Wilms' tumour, from 17% to 54% for osteosarcoma, from 26% to 61% for rhabdomyosarcoma, from 59% to 94% for malignant testicular germ-cell tumours and from 43% to 77% for malignant ovarian germ-cell tumours. These increases in population-based survival rates reflect the substantial advances in treatment of a wide range of childhood cancers since 1970. The two principal diagnostic groups for which there was no evidence of any trend were retinoblastoma, which already had an excellent prognosis with a 5-year survival rate of over 85%, and Ewing's sarcoma, for which the survival rate remained below 45%.

Adolescent↗
PubMed1990

International variations in the incidence of childhood renal tumours.

The International Agency for Research on Cancer has coordinated a worldwide study of childhood cancer incidence, with data from over 50 countries. We present here the results on renal tumours. Wilms' tumour was the most common malignant kidney tumour in all regions. It is sometimes considered to be an 'index cancer of childhood' but it is clear from the present study that there is at least a threefold difference in incidence between the age-standardised annual rates of over 10 per million in the Black populations in the United States and Nigeria and those of around three per million in several East Asian populations. In White Caucasian populations, Wilms' tumour had an annual incidence of 6-9 per million, accounting for 5-7% of all childhood cancer. It was almost everywhere equally common in boys and girls, but the sex ratio in East Asia was M/F = 1.4:1. Age distributions were similar among White Caucasian and Black populations, with the peak incidence in the second year of life. In East Asia, however, 25-40% of the total incidence occurred in infants aged under 1 year, compared with around 15% in many Western series. Other studies have shown that, in the United States, Wilms' tumour has a lower incidence among Asian children than among Whites or Blacks and tends to occur at a younger age. The variation in patterns of incidence of Wilms' tumour along ethnic rather than geographical lines suggests that genetic predisposition is important in its aetiology. Renal carcinoma in childhood is rare throughout the world, with little sign of international variation. It accounted for a higher proportion of childhood renal tumours in East Asia but this was attributable to the lower incidence of Wilms' tumour in that region.

Adolescent↗
PubMed1990

International variations in the incidence of childhood lymphomas.

The International Agency for Research on Cancer has coordinated a worldwide study of childhood cancer incidence, with data provided by contributors from over 50 countries. We present here the results on lymphomas from this study and other sources. Hodgkin's disease had a relatively high incidence in North Africa and West Asia and a low incidence throughout East Asia. In populations of predominantly European origin, the highest rates tended to be in warmer countries of lower latitude. In industrialised Western countries, the incidence increased steeply with age and was low in childhood compared with that in young adults whereas elsewhere the increase in incidence between childhood and adults aged 20-34 was much less marked. The age-distribution of Hodgkin's disease in childhood appears to be related to levels of socio-economic development but the total incidence seems to be determined more by ethnic and environmental factors. The highest incidence of Burkitt's lymphoma occurred in tropical Africa and Papua New Guinea. Elsewhere, Burkitt's lymphoma was rare, though the incidence was higher in Spain, North Africa and the Middle East than in other areas. In most Western countries, a third of all non-Hodgkin lymphomas may be Burkitt's. There was no consistent pattern in the incidence of other non-Hodgkin lymphomas except for a tendency towards higher rates around the Mediterranean and in some Latin American registries.

Adolescent↗
PubMed1990

Prognosis of Down's syndrome with acute leukaemia.

The outcome in children with acute leukaemia with (n = 90) and without Down's syndrome (n = 4377) was compared. Sixty three (70%) of those with Down's syndrome had acute lymphoblastic leukaemia and in comparison with 3664 (84%) controls had similar prognostic features except for a significant excess of the 'common' immunological subtype of acute lymphoblastic leukaemia. The outcome of the children with Down's syndrome was significantly worse with a five year overall actuarial survival of 28% compared with 59% in the control group. It appeared that both suboptimal chemotherapy and a high rate of infective problems contributed to the poor survival. Twenty six children with Down's syndrome had acute myeloblastic leukaemia and were significantly younger and had a higher percentage of the megakaryocytic and erythroid subtypes of acute myeloblastic leukaemia than the 713 controls. The outcome was similar in the two groups. It is concluded that the patients with Down's syndrome who develop acute leukaemia should receive standard protocols without modification, but aggressive supportive care is necessary to improve outcome.

Adolescent↗
PubMed1990

The inter-regional epidemiological study of childhood cancer (IRESCC): case-control study of children with central nervous system tumours.

Tumours of the central nervous system comprise 23% of all childhood cancers and form the most common group of solid malignancies. Little is know about their aetiology. The present report concerns the results of a case-control study of 78 incident cases of central nervous system tumours in children. No case-control differences were detected for the following: pre-natal diagnostic X-rays, general anaesthetics during pregnancy, pregnancy infections, pregnancy drugs (including sedatives, tranquillizers and anti-convulsants), alcohol consumption in pregnancy, child's birthweight, breast-feeding, childhood illnesses, previous medication in the child. A significant excess of case mothers had suffered from diseases of the nervous system (RR 2.6). There was a deficit of children who had been immunised among the case children which approached significance, and an excess of congenital abnormalities among cases which also approached significance. There was a small excess of neoplastic disease among case parents. The results of this study suggest that in our patients genetic rather than environmental factors are more important, but the small numbers included in the present study meant that no definite conclusions could be reached.

Abnormalities, Multiple↗