Cancer research successes

29 April 2015
University of Oxford spires
A meeting to celebrate the work and achievements of the Childhood Cancer Research Group (CCRG), University of Oxford, 1975 - 2014.

Thursday 16th April 2015
Some of the UK’s leading figures in childhood cancer research and treatment gathered at the University of Oxford in tribute to a group that has been at the heart of childhood cancer research in the UK for the last four decades.

The establishment of the Childhood Cancer Research Group (CCRG) in 1975 happened in an era when the overwhelming majority of young cancer patients died. The very first national trials in childhood cancer had taken place within the previous few years (in leukaemia and Wilms tumour) and survival was beginning to increase within some groups of patients.

Built on the founding work of Dr Alice Stewart, who established the Oxford Survey of Childhood Cancers in the 1940s, the Group housed the National Registry of Childhood Tumours (NRCT) which, over the years, has become possibly the most important childhood cancer registry in the world. Under the leadership of Dr Gerald Draper, the Group’s emphasis was on future outcomes including long-term survival, second primary tumours and the subsequent health burden for survivors.  

It has been a remarkable 40 years for paediatric oncology. In 1975, less than 4 out of 10 children diagnosed with cancer survived for five years. The establishment of the CCRG was part of a dawning recognition that childhood cancers were different to adult cancers and needed special handling, and coincided with a sea change in the way that childhood cancer was managed in the UK.

Paediatric oncology was recognised as a new specialty for the first time in the 1970s, collaborations began to be formed between different treatment centres and the UK Children’s Cancer Study Group (UKCCSG) was set up in 1977 with the aim of improving the management of children with cancer and advancing the knowledge and study of childhood malignancy. The first national clinical trials were carried out in brain tumours, Ewing sarcoma and non-Hodgkin lymphoma. Progress continued apace to the point where, today, more than 8 out of 10 children with cancer are still alive five years from diagnosis. The CCRG has played an important role in driving forward the changes that have underpinned these improvements in survival; early studies showed survival advantages for those being treated in specialist centres as well as those taking part in clinical trials and this shaped practice going forward.

Charles Stiller has headed up the NRCT since the 1990s and his meticulous analyses of childhood cancer incidence, mortality and survival have given tremendous insights that have helped shape policy, treatment and research. It is thanks to his lifelong working dedication that we have become so accustomed to having easy access to an immense wealth of detailed information on childhood cancer to guide us in our work.

Following the work of Alice Stewart, which established a link between maternal obstetric x-ray exposure and childhood cancer, the Group has carried out diverse projects addressing the role of ionising radiation in the aetiology of childhood leukaemias in particular. Following the 1983 Yorkshire Television report on the Sellafield leukaemia cluster, the Group became involved in long-running studies into the possible relationship between childhood cancer and (proximity to) nuclear installations and processing plants. Over the years, and under the leadership of Dr Mike Murphy since 2003, other avenues of aetiological research have included non-ionising radiation (electric and magnetic fields), twinning and infertility treatments, intrauterine growth and birthweight and infectious disease exposure as well as genetic studies on risk. Whilst it is fair to say that the causes of childhood cancer remain largely unknown, we have gained important insights along the way.

The NRCT research dataset is undoubtedly one the best of its kind worldwide and it is imperative that the data, and access to it, is maintained. Whilst specialist local registries are important, a comprehensive national registration system- with linkage to clinical datasets and suitable control populations - is essential in order to continue to drive forward our understanding both of childhood cancer aetiology and of the health care needs of survivors. The ability to link with international datasets is growing, both for worldwide comparisons and pooling of data to address specific research questions.

Whilst the new registration systems bed down within Public Health England, we will watch and wait to see how well they carry the mantle of what has gone before.

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