If you would understand anything, observe its history and development. —Aristotle
Like most medical disciplines, radiology is relentlessly forward looking, always tending to focus on the latest innovations. Journal articles and continuing medical education courses are replete with the latest developments in imaging science and technology, outlining their implications for the daily practice of radiology. This is both natural and good. However, there are risks in gazing only in the forward direction and never pausing to reflect on where we have been. For one thing, we cannot draw lessons from our mistakes and successes unless we reflect on our past. Moreover, understanding the contributions of predecessors can enhance our appreciation for the value of the capabilities we currently enjoy, ensuring that we do not take them for granted. Above all, we cannot see our current location and trajectory unless we understand where we have come from.
One of the most remarkable stories in medicine in the latter half of the 20th century was the successful battle against many pediatric cancers. For example, about 3000 children each year are diagnosed with acute lymphoblastic leukemia. In the 1950s as today, a child 3 to 5 years of age would present to a physician’s office with complaints of pallor, shortness of breath, bruising, headaches, and lack of appetite. A blood smear would show a large number of lymphocytic blasts. In 1950, effective treatments were unavailable, and the question was not whether the patient would die, but how soon. Today, patients diagnosed with acute lymphoblastic leukemia enjoy a 90% survival rate. Happily, such progress has not been restricted to leukemias, and the overall survival rate of US children diagnosed with cancers of all types has risen from approximately 10% in 1950 to >80% today.
Cancer in childhood is relatively uncommon, accounting for only 13,000 of the 1.3 million new US cancer diagnoses each year. This being said, however, children’s cancers have served as important models for the management of cancers in patients of all ages. Pediatric oncologists were pioneers in the use of multi-institutional trials to develop and evaluate diagnostic and therapeutic protocols, through such initiatives as the National Wilms Tumor Study Group, the Children’s Cancer Research Group, and the Pediatric Oncology Group. Many of the findings of these groups, such as the value of multimodality therapy, were first identified in children. By treating the care of every patient as a learning opportunity and widely sharing the lessons learned, pediatric oncology opened up new pathways in the treatment of all cancer patients.
Radiology has been privileged to play a vital role in the battle against pediatric cancers. This battle coincided with the introduction of a number of new mainstays in clinical imaging, such as sonography, computed tomography (CT), magnetic resonance (MR) imaging, and nuclear medicine. Without the abilities these new imaging modalities provided to diagnose, stage, assess treatment response, and maintain surveillance for recurrence, many advances in pediatric oncology would not have been possible. Many radiologists who trained in the past few decades may not appreciate the magnitude of the difference radiology has made. The purpose of this article is to survey the nature of radiology’s contribution to the care of pediatric cancer patients. To do so, we focus on three illustrative pediatric cancers: primary central nervous system (CNS) malignancies, Hodgkin’s lymphoma, and Wilms tumor.
Central nervous system malignancies
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Hodgkin’s Lymphoma
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Wilms Tumor
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Conclusions
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References
1. Gupta N., Banerjee A., Haas-Kogan D.: Pediatric CNS Tumors.2009.SpringerNew York
2. Hoppe R.T., Mauch P.T., Armitage J.O., et. al.: Hodgkin Lymphoma.2007.Wolters KluweverPhiladelphia, PA
3. Hellman S.: Thomas Hodgkin and Hodgkin’s disease: two paradigms appropriate to medicine today. JAMA 1991; 265: pp. 1007-1010.
4. Gouch M.H.: Lymphangiography in children. Arch Dis Child 1964; 39: pp. 177-181.
5. Geller E., Kochan P.S.: Renal neoplasms of childhood. Radiol Clin North Am 2011; 49: pp. 689-709.
6. Boklan J.: Little patients, losing patience: pediatric cancer drug development. Mol Cancer Ther 2006; 5: pp. 1905.