ID #845 Princess Máxima national Center for pediatric oncology with integrated care of Oncological Pediatric Neurosurgery; an evaluation after 8 years.
Eelco Hoving, Oscar Eelkman Rooda, Mariska SieAbstract
Introduction
Since June 2018, all pediatric oncology patients in the Netherlands are treated in our national center Princess Máxima. Oncological pediatric neurosurgery is an integrated activity of this national Neuro-oncology practice with around 160 neurosurgical tumor related procedures (120 resections, forty biopsies). The impact of both concentration of patients and of medical expertise and the value of an integrated multidisciplinary pediatric neuro-oncology team will be put into perspective of the last eight years with focus on oncological pediatric neurosurgery.
Methods
An optimal pediatric neurosurgical infrastructure was established. All resected tumor tissues will be immediately processed both for diagnostics and for research. Neuro-oncology research groups are active varying from basic to translational and clinical research. Innovative technologies are explored for implementation during surgery. Per-operative Drug Delivery protocols have been designed for early phase studies and collaboration with study consortia have been engaged.
Results
A dedicated Intra-Operative (IO)-3T MRI operating theatre with fully integrated infrared navigation system has been used in a standard fashion with 2 sessions weekly for various brain tumor resections. This operating room serves as a platform for implementation of innovative technologies like augmented reality (holography) and advanced per-operative imaging (DKI and ASL). The ultrafast nanopore-AI algorithm (Sturgeon) has been validated for per-operative methylation-based tumor tissue diagnostics affecting surgical decision making concerning radicality versus morbidity (supported strategy 86% but changed strategy 14%; n = 63). Fresh tumor tissue will be processed into a tumor organoid pipeline available for drug screening and stored within the Biobank. A detailed complication registration is registered on all neurosurgical patients. The Brain care program provides neurocognitive testing data for all children with brain tumors. An extensive early-phase study portfolio is opened in collaboration with the consortia PNOC, Connect and ITCC.
Conclusion
Oncological pediatric neurosurgery integrated within a large pediatric oncology center creates new opportunities and values for children with tumors of the central nervous system. This may contribute to improvement of outcome for these children.