Jeannette Parkes

SIOP PODC adapted treatment recommendations for standard-risk medulloblastoma in low and middle income settings

Effective treatment of children with medulloblastoma requires a functioning multi‐disciplinary team with adequate neurosurgical, neuroradiological, pathological, radiotherapy and chemotherapy facilities and personnel. In addition the treating centre should have the capacity to effectively screen and manage any tumour and treatment‐associated complications. These requirements have made it difficult for many low and middle‐income countries (LMIC) centres to offer curative treatment. This article provides management recommendations for children with standard‐risk medulloblastoma (localised tumours in children over the age of 3–5 years) according to the level of facilities available. Pediatr Blood Cancer 2015;62:553–564.

Intracystic interferon therapy in childhood craniopharyngioma: who, when and how?

A 13‐year‐old male presents with fluctuating visual disturbance and headaches. Imaging reveals a significant predominantly cystic suprasellar tumour, typical of a craniopharyngioma. The patient has growth hormone deficiency but the rest of the hypothalamic/pituitary axis is intact. What are the options for therapy in 2014? Specifically, is there a role for local treatment with interferon injected into the cyst cavity? The aim of management in children with craniopharyngiomas is to reduce the impact of the tumour as much as possible, while minimising the morbidity associated with treatment. There are a number of therapeutic options available: surgery, radiotherapy and the insertion of therapeutic agents directly into the tumour cyst. The role of intracystic therapy in the form of interferon is discussed; including when to use this therapeutic option and practical details of its use.

Rare Tumors in Pediatric Oncology

We define rare tumors in pediatric oncology arbitrarily as including the following histologies: retinoblastoma, nasopharyngeal carcinoma, desmoid, non-CNS germ cell tumors, liver tumors, pleuropulmonary blastoma (PPB), chordoma, malignant peripheral nerve sheath tumors, and for some the true connective tissue tumors. Relative to adult tumors, practically every tumor in this text could be considered rare but these histologies are rare even within the scope of pediatric care.

Global Challenges in Pediatric Neuro-Oncology

Eighty-five percent of the world’s children live in areas of limited resources. The poorest continent, Africa, accounts for 23% of pediatric disease but only employs 1.3% of the world’s health workers. Pediatric neuro-oncology requires highly specialized teams, and in countries where there are inadequate resources for even the most common diseases, such as infections, malnutrition, and HIV-related disease, it is understandable that children with central nervous system (CNS) tumors are not a priority.

Pediatric Radiotherapy in Low and Middle Income Countries

Communicable diseases are still the leading cause of childhood mortality in third world countries. However, as prevention and treatment of malnutrition and infectious diseases improves, global health challenges are shifting towards combating non-communicable diseases including cancer which has high rates of mortality in children (Wilimas and Ribeiro 2001). More than two-thirds of the world’s pediatric cancers are currently diagnosed in low- and middle income countries (LMIC) (Kellie and Howard 2008). The patterns of occurrence of childhood cancer in LMIC compared to high income countries (HIC) and the lack of population-based cancer registries suggest that many patients die from undiagnosed cancer and the burden of childhood cancer is under-estimated. Children diagnosed with cancer in low-income countries (LIC) continue to have a much poorer chance of survival compared to those in HIC (Fig. 21.1).

Radiation planning assistant - A streamlined, fully automated radiotherapy treatment planning system

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated arc therapy (VMAT) plans for patients with head/neck cancer and 4-field box plans for patients with cervical cancer. It is a combination of specially developed in-house software that uses an application programming interface to communicate with a commercial radiotherapy treatment planning system. It also interfaces with a commercial secondary dose verification software. The necessary inputs to the system are a Treatment Plan Order, approved by the radiation oncologist, and a simulation computed tomography (CT) image, approved by the radiographer. The RPA then generates a complete radiotherapy treatment plan. For the cervical cancer treatment plans, no additional user intervention is necessary until the plan is complete. For head/neck treatment plans, after the normal tissue and some of the target structures are automatically delineated on the CT image, the radiation oncologist must review the contours, making edits if necessary. They also delineate the gross tumor volume. The RPA then completes the treatment planning process, creating a VMAT plan. Finally, the completed plan must be reviewed by qualified clinical staff.

SIOP PODC Adapted treatment guidelines for low grade gliomas in low and middle income settings

Effective treatment of children with low grade glioma (LGG) requires a functioning multi‐disciplinary team with adequate neurosurgical, neuroradiological, pathological, radiotherapy and chemotherapy facilities and personnel. In addition, the treating centre should have the capacity to manage a variety of LGG and treatment‐associated complications. These requirements have made it difficult for many centers in low and middle‐income countries (LMIC) to offer effective treatment and follow up. This article provides management recommendations for children with LGG according to the level of facilities available.

Improving the quality of care for children with brain tumours in South Africa: A report from the 4th Paediatric Brain Tumour Workshop

The 4th annual Paediatric Brain Tumour Workshop was held on 16 and 17 November 2013 at the University of Cape Town (UCT), South Africa (SA). The focus of this workshop was the management of children with brain tumours in limited-resource settings. Although brain tumours are the second-most common cancer in children, brain tumour awareness among the SA public and its physicians is low, with few centres being adequately equipped to manage affected children or having functioning multidisciplinary teams (MDTs). Currently, there are no national protocols or consensus agreements on how best to manage childhood brain tumours in SA.