Summary The National Registry of Childhood Tumours contains over 51 000 records of children born in Great Britain who developed cancer under the age of 15 years. Patterns of childhood cancer among families containing more than one child with cancer have been studied. A total of 225 'sib pair' families have been ascertained from interviews with parents of affected children, from hospital and general practitioner records and from manual and computer searches of names and addresses of patients. A number of special groups have been identified, including those with a known genetic aetiology such as retinoblastoma, twins and families with three or more affected children. A further 148 families not in any of the above groups contain two children with cancer: in 46 families the children had tumours of the same type, most commonly leukaemia. Some of the families are examples of the Li-Fraumeni syndrome; some are associated with other conditions, including Down's syndrome. There is clearly a genetic element in the aetiology of cancer in some families discussed here; shared exposure to environmental causes may account for others and some will be simply due to chance.

until the end of 1973, 98 children (57% of all eligible children) were included in the trial. Of the 313 children, 288 (92%) had a nephrectomy, 248 (79%) received a course of radiotherapy, and 267 (85%) were given at least four days' chemotherapy. The three-year survival rate was 58%; the rate among children in the trial (77%) was significantly better than that among children who were eligible for the trial but not included (58%). Children who had nephrectomies at specialised children's and teaching hospitals had a higher survival rate than those treated elsewhere.All children with nephroblastoma should be treated according to well-defined protocols which take into account the age of the child and the stage of the tumour and include a full course of maintenance chemotherapy.

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Summary In a population-based series of 368 children undergoing surgery for medulloblastoma, 304 (83%) survived to complete a course of radiotherapy. Among those patients who completed radiotherapy, the shortterm survival rates were lower for young children (those aged under 5 years) than for older children, but by 6 years the survival rates were very similar (-35%) for children in both age groups. Higher survival rates were obtained in the young children where total macroscopic excision of the tumour was achieved. For older children there was no difference in survival rates between those with total or partial excision, though the survival rate was lower for those whose surgery was limited to biopsy. In young children radiotherapy dose had no effect on survival rates. In older children, survival rates were appreciably higher where doses had been at least 45Gy to the posterior fossa and 30Gy to the spinal cord, and there were also fewer spinal cord metastases among those who received a higher spinal cord dose. Ninety (30%) of the 304 children also received chemotherapy as part of their initially planned treatment; a wide variety of protocols was used and no conclusions could be drawn as to the effects on survival rates.In the past, medulloblastoma has been generally regarded as having a very poor prognosis. The 3-year and 5-year survival rates for children diagnosed in Great Britain during 1962-70 were only 25% and 18% respectively (Draper et al., 1982). Treatment during this period consisted of surgery, with varying degrees of removal of the tumour, followed by a course of radiotherapy; chemotherapy was sometimes used to treat recurrences. From 1970, at an increasing number of centres, children were also given chemotherapy as part of their initial treatment in addition to surgery and radiotherapy (Bloom, 1979;Marsden & Steward, 1976), and clinical trials were set up to study the effect on survival of maintenance chemotherapy (Berry et al., 1981;Gerosa et al., 1981). The purpose of the present analysis is to examine the possible effects on survival of variations in the initial planned treatment of childhood medulloblastoma.

Summary.-Analysis of data from 1434 children with primary renal tumours revealed 57 who developed bone metastases. Of these, 54 were initially recorded as nephroblastoma. Fifty-two of the 57 cases were reviewed histologically, and only 18 were found to be Wilms' tumours. Twenty-three were classified as "Bone-Metastasizing Renal Tumour of Childhood" (BMRTC), and a high male incidence was found for these tumours (M:F=6-7:1). Differences in the pattern of metastasis and the one-year survival between BMRTC and nephroblastoma are discussed. The rarity of bone metastases from true Wilms' tumours is emphasized.