Old Man River - The flow of pediatric oncology

The origins of a river can be traced back to individual springs and freshet s. Their waters flow together to form brooks and rivulets, which empty into river branches and eventually into the main stream itself. Here and there, the waters are dammed and the pooled waters diverted to provide needed sus tenance to fields under cultivation. In a similar fashion, the flow of mode rn pediatric oncology can be traced back to observations made by individual investigators, then to studies conducted within single institutions. These institutions pooled their research and their talents to form first small c onsortia, then multi-institutional cooperative study groups. Through furthe r consolidation, these groups coalesced into intergroup research teams. Ref erence laboratories and tissue repositories-the millponds of clinical resea rch-were established to review and confirm diagnoses and to furnish materia l for laboratory and other basic research endeavors. This pattern can be tr aced back for most of the entities included under the rubric pediatric onco logy but it is more convenient and informative to do so with respect to two specific entities: acute lymphoblastic leukemia (ALL) and Wilms' tumor. Th ese malignancies are used as surrogates for the liquid and solid tumors.