Nisreen Amayiri

Retrospective analysis of pediatric cancer patients diagnosed with the pandemic H1N1 influenza infection.

Limited data are available on disease characteristics and outcome of children with cancer who contracted the H1N1 influenza infection during the 2009 pandemic.

Sustained Response to Targeted Therapy in a Patient With Disseminated Anaplastic Pleomorphic Xanthoastrocytoma

Pleomorphic xanthoastrocytoma is a rare brain tumor with unique high frequency of BRAF V600E mutation which is plausible for targeted therapy. The anaplastic variant has generally worse prognosis. We present an adolescent patient with a disseminated relapse of anaplastic pleomorphic xanthoastrocytoma following surgery, radiotherapy, and chemotherapy. She had a dramatic and prolonged response to a BRAF inhibitor (Dabrafinib) and later to addition of a MEK inhibitor (Trametinib) on tumor progression. With minimal side effects and a good quality of life, the patient is alive more than 2 years after initiation of targeted therapy. This experience confirms the potential role of targeted treatments in high-grade BRAF-mutated brain tumors.

Pediatric Neuro-Oncology in Countries with Limited Resources

Pediatric central nervous system tumors are a leading cause of cancer-related mortality and morbidity in high-income countries. Limited data are available concerning the incidence of these tumors in low-income countries, due to lack of proper cancer registries and shortage of publications. The management of childhood brain tumors faces several challenges in countries with limited resources. Delayed presentation, insufficient number of specialists (pediatric neurosurgeons, pediatric oncologists, and radiation oncologists), and shortage of radiological diagnostic tools like MRI, of neurosurgical equipment, or of radiation machines are significant obstacles. In addition, abandonment of treatment and loss of follow-up are common, mostly for social or economic reasons. Pediatric neuro-oncology is relatively a new subspecialty and requires close multidisciplinary teamwork. This is attempted but not efficiently executed in many developing countries. Some of these difficulties can be managed by enriching the resources through international collaborations; others may need shared experience with more advanced countries through twinning programs. Successful experiences have been conducted in the recent years that demonstrate the possibility to improve the care of children with brain tumors in countries with limited resources.

Video-Teleconferencing in Pediatric Neuro-Oncology: Ten Years of Experience

Purpose The management of central nervous system tumors is challenging in low- and middle-income countries. Little is known about applicability of twinning initiatives with high-income countries in neuro-oncology. In 2004, a monthly neuro-oncology video-teleconference program was started between King Hussein Cancer Center (Amman, Jordan) and the Hospital for Sick Children (Toronto, Ontario, Canada). More than 100 conferences were held and > 400 cases were discussed. The aim of this work was to assess the sustainability of such an initiative and the evolution of the impact over time. Methods We divided the duration in to three eras according to the initial 2 to 3 years of work of three consecutive oncologists in charge of the neuro-oncology program at King Hussein Cancer Center. We retrospectively reviewed the written minutes and compared the preconference suggested plans with the postconference recommendations. Impact of changes on the patient care was recorded. Results Thirty-three sets of written minutes (covering 161 cases) in the middle era and 32 sets of written minutes (covering 122 cases) in the last era were compared with the initial experience (20 meetings, 72 cases). Running costs of these conferences has dropped from

Safety of inadvertent administration of overdose of intrathecal Cytarabine in a pediatric patient

360/h to <

Feasibility of high-dose chemotherapy protocols to treat infants with malignant central nervous system tumors: Experience from a middle-income country

40/h. Important concepts were introduced, such as multidisciplinary teamwork, second-look surgery, and early referral. Suggestions for plan changes have decreased from 44% to 30% and 24% in the respective consecutive eras. Most recommendations involved alternative intervention modalities or pathology review. Most of these recommendations were followed. Conclusion Video-teleconferencing in neuro-oncology is feasible and sustainable. With time, team experience is built while the percentage and the type of treatment modifications change. Commitment and motivation helped maintain this initiative rather than availability of financial resources. Improvement in patients’ care was achieved, in particular, with the implementation of a multidisciplinary team and the continuous effort to implement recommendations.

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

Purpose To describe a medication error of intrathecal Cytarabine overdose that was managed conservatively with no apparent toxicities. Summary An 11-year-old girl was diagnosed with bone marrow relapsed precursor B-cell acute lymphoblastic leukemia. According to her chemotherapy protocol, she was started on triple intrathecal chemotherapy consisting of Methotrexate, Cytarabine and Hydrocortisone on day 1 of the protocol. After the intrathecal therapy being administered to the patient, the pharmacist who checked the medication realized that the wrong formulation of Cytarabine was used to prepare the intrathecal therapy; this error resulted in five times overdose of Cytarabine. The patient was then managed conservatively without cerebrospinal fluid exchange. Our patient remained clinically and neurologically stable without apparent toxicities and was discharged safely from hospital. Conclusion Supportive care without the need for invasive procedures such as cerebrospinal fluid exchange may be adequate for managing intrathecal Cytarabine overdose.

Paediatric Neuro-Oncology

Results of high‐dose chemotherapy (HDCT) protocols for the management of malignant central nervous system (CNS) tumors in infants are mostly reported in high‐income countries. We evaluated the feasibility and results of such protocols in a middle‐income country (Jordan).

High frequency of mismatch repair deficiency among pediatric high grade gliomas in Jordan.

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.

Review of management and morbidity of pediatric craniopharyngioma patients in a low-middle-income country: a 12-year experience

Paediatric central nervous system tumours are a leading cause of cancer-related mortality and morbidity in high-income countries. Limited data are available concerning the incidence of these tumours in low-income countries, due to lack of proper cancer registries and shortage of publications. The management of childhood brain tumours face several challenges in countries with limited resources. Delayed presentation, insufficient number of specialists (paediatric neurosurgeons, paediatric oncologists and radiation oncologists), shortage of radiological diagnostic tools like MRI, of neurosurgical equipment or radiation machines are significant obstacles. In addition, abandonment of treatment and loss of follow-up are common, mostly for social or economic reasons. Paediatric neuro-oncology is relatively a new subspecialty and requires close multidisciplinary team work. This concept is not emphasized in many developing countries. Some of these difficulties can be managed by enriching the resources through international collaborations; others may need shared experience with more advanced countries through twinning programs. Successful experiences have been conducted in the recent years that demonstrate the possibility to improve the care of children with brain tumours in countries with limited resources.