The purpose of this project is to identify optimal treatment for malignant diseases in children through continuing collaborative studies within the Children's Cancer Study Group. Statistically valid selection of these treatments which are most effective in prolonging survival of children with cancer cannot be achieved in a reasonable period of time within single institutions. Interinstitutional collaborative studies provide a more efficient means of achieving such a goal. These studies utilize standardized protocols variously designed to determine (a) dosage and toxicity of new drugs (Phase I.1, (b) efficacy of select drugs for specified malignancies (Phase II), and (c)-the.best of alternative treatments for a given disease by-means of randomized clinical trials (Phase III). A multidisciplinary diagnostic and therapeutic effort is essential for the current optimal management of the child with cancer. The proposed project will formalize our efforts to develop a coordinated, cooperative approach to management within our own institution that includes among others, chemotherapists, radiation therapists, surgeons, pathologists, immunologists, cytogeneticists, and pharmacologists. To enhance our ability to care for the infants and children of North Carolina with cancer, the joint collaboration with an interinstitutional cooperative group becomes essential. Such a collaboration will promote interdisciplinary functions, enrich teaching and clinical research within our institution, and help to introduce optimal approaches to the diagnosis and treatment of childhood cancer to our referring physicians and others at the community level.