NOSC Newsletter 4Feb 2013 2(1)

8/11/2019 NOSC Newsletter 4Feb 2013 2(1)

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What youll find in this edition:

NOSC steering board; lining up mid

to long-term strategies

Isfahan NOSC meeting held

December 27th, 2012.

NOSC and the annual conference ofclinical oncology:

ISRO..

NOSCs publication record and

manuscripts under review.

NOSC Case Study Periodical

Neuro-Oncology Event Updates

NOSCs Brain Tumor Collaborative

Registry (BTCR) successfully in

place..

Neuro-Oncology News blast.

NOSC Newsletter 2013 Feb 2 1 www.behestandarou.co


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NOSC steering board; lining up mid-long term strategies

Neuro-Oncology Scientific Club (in short, NOSC) is a local initiative by Iranianneuro-oncology experts who have particularly been interested in optimal management of

brain tumor patients. It has been almost a year and half since NOSC started its journey.Currently, the steering board of NOSC is officially consolidated. This executive committee is

composed of delegates from allied national scientific societies including Iranian CancerSociety, Society of radiation Oncology, National Society of Surgeons (Neurosurgery Branch),Pathology and Radiology Societies. In addition, chairs from the so far held NOSC meetingshave been invited to be part of this committee.

The so far steering board members are (alphabetically):

Dr. Amouheidari Isfahan NOSC lead-facultyDr. Anvari Mashhad NOSC lead-facultyDr. Fazlalizadeh Iranian Cancer SocietyDr. Ghadyani Iranian Cancer SocietyDr. Haddad Iranian Society of Radiation OncologyDr. Hashemi Iranian Radiology Society

Dr. Hedayati Iranian Society of Pediatric Hematology-OncologyDr. Mosallaie Shiraz NOSC lead-facultyDr. Nayyeri Iranian Radiology SocietyDr. Nilipour Iranian Pathology SocietyDr. Samiei Iranian Society of Radiation OncologyDr. Seyyednejad Tabriz NOSC lead-facultyDr. Tabatabaeefar Iranian Society of Radiation OncologyDr. Vosough Iranian Society of Pediatric Hematology-OncologyDr. Zali National Society of Surgeons (Neurosurgery Branch)Dr. Zendehdel National Cancer Research Network

Following, Mashhad, Tehran and Isfahan NOSC meetings in 2011-2012, based on

the steering board decisions, the forthcoming NOSC meetings (2013) will be soon conductedsequentially in Mashhad, Tehran, Shiraz and Tabriz and Ahvaz. NOSC continues to cross thebridge between different disciplines professionals who actively take part in brain tumormanagement, meanwhile the steering board committee is committed to let this effectivelyhappen.

NOSC NewsletterVolume 2, Edition 1, Feb 2013Editorial Desk:2ndFloor, Sorayya Bldg., #10 Pardis St., Mollasadra Ave., 1991915613+982188774200 ext. 1634

NOSC Newsletter 2013 Feb; 2(1) www.behestandarou.com


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Isfahan NOSC meeting held December 27th, 2012

The NOSC members of Isfahan conducted this constructive meeting as an interdisciplinary

activity to refocus for better care in glioma.

The below visual reminds us the day when our colleagues in Isfahan passionately contributedto the meeting aims. During the above meeting, Isfahan experts from brain tumor allied

disciplines communicated ideas on trends in management of HGG, trying to highlight the

practical hints in interdisciplinary care leading to the more favorable outcome in glioma

management.

5) Within NOSC, the communicated updates and evidence-based inputs will beincorporated to a local consensus algorithm, primarily for the management of HGG.

6) NOSC will contribute to organize and conduct CNS tumor boards in Isfahan.Interesting cases will be reported in NOSC case study periodical and subsequently published

in its dedicated website.7. The following Isfahan NOSC meeting will be in early May 2013. Provincial brain tumorepidemiological updates, progress report in radiodiagnostic measures, dataset review fromthe first phase data gathering through BTCR, will constitute the main part of the nextmeetings agenda.

We all look forward to better patient care plus constructive medical insights from theabove NOSC session and further such meetings in different provinces, coming up

NOSC members, collaborators andconsultants shared ideas to arrive at acommon place for the vision, missionand forthcoming plans of this newlyestablished scientific club in Isfahan.Isfahan NOSC would try to foster a teamwork in diagnosis, treatment and followup of brain tumor patients. Below are the

shared decisions made during thismeeting.

1) Everyone agreed with NOSCsrationale, vision and mission and the ideaof having periodical meetings for theexchange of experience to achieve itsdefined goals.

2) NOSCs ultimate aim will beimproving our brain tumor patientshealth and quality of life through aninterdisciplinary team work.

3) Participation of expertphysicians/scientists from all allied

disciplines should be further encouraged.4) The final version of the brain tumorcollaborative registry (BTCR) which isalready developed by NOSCs parallelworking-groups, will be installed indesignated cancer care centers in Isfahan.This would help a more organized braintumor data gathering within the province.



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NOSC and the annual conference of clinical oncology ISRO

The 8th annual conference of clinical oncology was conducted 16-17 Jan 2013, in Imamconference hall, Imam Khomeini Hospital- Tehran. This conference hosted experts from

various medical fields and facilitated transparent talks/ exchange of ideas and scientificdiscussions on cancer management. As a part of the conference schedule, NOSC hosted asymposium entitled: CUTTING-EDGE TRENDS IN GLIOMA MANAGEMENT.

During this interactive symposium Drs. Haddad and Tabatabaeefar initiated the meetingby an introduction to NOSC and chaired the final panel discussion.

The topics: 1- Elderly Patients with malignant astrocytomas, has the treatment paradigmreceived changes? 2- The role of chemotherapy in anaplastic astrocytoma and anaplasticoligodendroglioma, the case selection dilemma. And 3- Pseudoprogression and undeservedpremature stop in GBM chemotherapy, were eluded to by Dr. Salmanian, Dr.Yaghoobi andDr.Torabi Nami, respectively.

The presented slides will be soon available on NOSC dedicated webpage.In addition, the NOSC got its submitted manuscript entitled: Brain Tumor Care in

Iran and the Neuro-Oncology Scientific Club (NOSC); Welcoming Outreachfrom Within. By [Haddad P., Anvari K, Zali A.R., Tabatabaeefar M., Bahadorkhan G.,Mosallaie A., Amouheidari A., Hemmati S., Mohammadzadeh F., Hejazi Farahmand S.A,Torabi Nami M.] published in the conference proceeding of this event.



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NOSCs publication record and manuscripts under review

By now you know that NOSC has succeeded to document its achievements through

international publications. Two PubMed indexed citations and 3 international widely indexed

peer reviewed publications are what NOSC has come up with so far.

http://neuro-oncology.oxfordjournals.org/content/14/suppl_1/i106.abstract #10

http://neuro-oncology.oxfordjournals.org/content/14/suppl_3/iii1.abstract #282

http://www.webmedcentral.com/wmcpdf/Article_WMC002381.pdf

http://www.sciencepub.net/report/report0402/007_8292report0402_42_53.pdf

http://www.bioinfo.in/uploadfiles/13470961443_5_2_IJMCR.pdf

Currently, NOSC has two other manuscripts under review:

1.

The Nexus Between Interdisciplinary Approach and Extended Survivalin CNS Tumors, Neuro-Oncology Scientific Club (NOSC) Meeting

Report, 27 December 2012, Isfahan, Iran

A. Amouheidari, S. Hemati, M.Sabouri, J. Emami, V. Mehrzad, A.Hekmatnia, B.Alian,

H.Rouhani Najafabadi, M. Torabi Nami on behalf of Isfahan NOSC

Submission Date:01/17/2013

Journal Title:Research In Cancer and Tumor by Scientific and Academic Publishing- SAP; USA

and current solutions, the practical medical considerations in glioma management and the

issue of recognizing glioblastoma multiforme pseudoprogression to avoid imposing a wrong

premature stop in chemotherapy were discussed during this event. The well-structured brain

tumor collaborative registry (BTCR) software which had already been developed by the

parallel working-groups within NOSC, was introduced during the session. The provincialbrain tumor epidemiological updates, progress report in radiodiagnostic measures and

dataset review from the first phase data gathering through BTCR, will be the main

constituents of the next Isfahan NOSC meeting, early May 2013.

Abstract:The Neuro-Oncology Scientific Club ( NOSC) is a relativelyestablished scientific community in Iran. NOSCs serial meetings inmajor provinces have focused on executive strategies to improve

brain tumor care through an interdisciplinary approach. Thecurrent report outlines the communicated insights and agreed-upon decisions during the first Isfahan NOSC meeting held on 27thDecember 2012 in Isfahan, Iran. Evidence and local trends onmaximal safe resection to improve outcome in gliomas with itspitfalls -



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1. Classifying pediatric CNS tumors through near optimal feature selectionand mutual information; A single center cohort

M.Faranoush, A. Mehrvar, A. Hedayati Asl, M. Tashvighi, R. Ravan Parsa, M. Ali Fazeli, B.Sobuti, N. Mehrvar, A. Jafarpour, R. Zangooei, M. Alebouyeh, M. Abolghasemi, A. Vahabi, P.

Vossough, M.Torabi Nami. Submission Date:11/20/2012. Journal Title:IndianJournal of Pediatric and Medical Oncology; Medknow; India

epidemiological features, mutual information and Least Square- Support Vector Machine

(LS-SVM) methods in MATLAB (matrix laboratory) software were used to propose apreliminary pediatric CNS tumors feature-label predictive model.Results: 63.1% and 36.9%of patients were males and females, respectively. Mean SD of age was 6.11 3.65 years. Interms of tumor location, 30.3%, 67.7% and 2% of tumors were supra-, infra-tentorial andspinal, respectively. High-grade glioma (supra-tentorial) [36 (59.99%)] and medulloblastoma(infra-tentorial) [65 (48.51%)] were the most frequently registered CNS tumors. Mostprevalent clinical findings were vomiting, headache and impaired vision. Gender, age,patients geographical origin, tumor stage and the presence of metastasis predicted the supra-tentorial tumors histology.Conclusion: Our data is relatively in line with earlier reports on CNS tumors epidemiology.Timely diagnosis and management of CNS tumors can lead to decreased disease burden andimproved survival. This may be facilitated through development of partitioning, risk

prediction and prognostic models.

Call for papers

NOSC has so far published 3 case discussions communicated by its lead faculties ( Drs.Haddad, Mosallaie, Taghipour, Amouheidari, Sabouri, Marashi). These case discussions

were published under NOSC case Study Periodical. The following 3 documents will be soonposted on NOSC webpage.

AbstractPurpose: Central nervous system tumors features-labels mutualinformation, clustering and classification may help predicting not onlydistinct diagnoses based on features but also the prognosis. To reachthis, we evaluated the epidemiological features in children with CNStumor who referred to Mahaks Pediatric Cancer Treatment andResearch Center (MPCTRC).Materials and methods: This cohort (convenience sample) comprised198 children ( 15 years old) with CNS tumors, referring to MPCTRCfrom 2007 to 2010. In addition to the descriptive analyses on-



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NOSC case study periodical continues to publish interesting brain tumor casestudies reported from joint neuro-oncology clinics in Iran. The main focus would be newlydiagnosed high grade glial brain tumors.

You might have encountered with brain tumor cases for whom the effective managementreally needs an interdisciplinary approach. They may not be typically case reports howeverthe way cross-disciplinary approach help the patient is of great clinical interest to readers.

The publishing source will be NOSC which is now evolving to become a recognized self-operated neuro-Oncology experts forum in national scope. As you know by now NOSC ishosting neuro-Oncology professionals and leads from various disciplines not limited toneurosurgery, radiation oncology, pathology, neuroradiology, hematology and oncology andneurology.

For those who are interested to contribute; following items of the reportable cases shouldbe taken into account:

- Initial oncology workup- Neurosurgical discussion- Antiepileptic prophylaxis-

Treatment response to concomitant chemoradiation and adjuvant therapy.- Radiation oncology commentary- Hematology oncology commentary- Further interesting details.



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We plan to publish cases with clinically valuable lessons. Therefore brain tumor cases withdiagnostic, ethical and therapeutic challenges or pharmacology and histopathology highlightsare deemed of particular educational value for NOSC Case Study Periodicalpapers.

Designated faculties from the NOSC board of experts will be called for pre-publicationreview of the presented cases.

NOSC Case Study Periodical is particularly interested to publish cases with following

criteria:- Newly diagnosed GBM- Interdisciplinary success in management of complex cases- Learning from errors- Rare presentations-

Unexpected outcome ( positive or negative) after chemoradiation withtemozolomide

- Adverse events after therapeutic regimens.

To learn more about the and detailed instruction to authors kindly [email protected] call 021-88774200 ext.1634

Neuro-Oncology event updates

1-EORTC EANO ESMO 2013

22-23 March 2013 in Prague, Czech RepublicEORTC-EANO-ESMO 2013 Meeting Trends in Central Nervous System MalignanciesMore information: http://www.ecco-org.eu/EORTC_EANO_ESMO



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2-ASNO 10thMeeting-IndiaThe 10th Meeting, Asian Society of Neuro-Oncology (ASNO) 2013, will be held in Mumbai,

India, on March 21-24. To learn more, you may visit http://www.asno2013.org/

3-Neuroweek

4-8 March 2013 in London, United KingdomA unique opportunity for neurosurgical trainees to reinforce the anatomical knowledge of thebrain and spinal cord through cadaveric dissections, lectures and tutorials. The week iscomprised of three modules on neurological anatomy, neuroradiology and approaches forintracranial surgery. You may attend some or all of the modulesMore information: http://www.rcseng.ac.uk/courses/course-search/neurosurgery-week

4-2013 World Federation of Neuro-Oncology

Meeting

The 4th Quadrennial Meeting of the World Federation of Neuro-Oncology to be held in

Conjunction with the 2013 Scientific Meeting and Education Day of the Society for Neuro-

Oncology (SNO)

You may want to mark your calendars for the 4th Quadrennial Meeting of the World

Federation of Neuro-Oncology to be held November 21-24, 2013, in San Francisco, CA.



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NOSCs Brain Tumor Collaborative Registry (BTCR)successfully in place

Neuro-Oncology News Blast

This is a new section added to our newsletter. In this part you may see snapshots of some of

the most relevant recently published papers in the field of brain tumor. Corresponding links

will redirect readers to the original source. We hope these updates would add to everyonesunderstanding on the most recent advances in brain tumor management.

Protracted low doses of temozolomide for the treatment of patients with

recurrent glioblastoma: A phase II study.

This article says that the every other week schedule of low dose temodal did not work for

recurrent glioblastomas who failed the standard schedule of temodal. The whole concept

reemphasized the applicability of standard protocol as per temodal label (Stupp protocol)

http://www.ncbi.nlm.nih.gov/pubmed/23205103

BTCR has receivedconstructive inputs fromNOSC parallel workinggroups so far.The first version of thisregistry software has already

been installed in some clinicsand oncology research centers

which actively provide care tobrain tumor patients.

For further information,please contact NOSCorganizing. You may call02188774200 ext. 1620.



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Gross Total Resection Rates in Contemporary Glioblastoma Surgery:

Results of an Institutional Protocol Combining 5-ALA Intraoperative

Fluorescence Imaging and Brain Mapping.

5-ALA is a dye used during brain tumor surgery to let the surgeon know where the tumor is.

This article shows that it helps increase the chances of a total resection for a Glioblastoma,

without increasing the complication rate. This dye is approved for use in Europe, but the

USA FDA has not yet approved it here. It is in clinical trials here and hopefully will be

approved soon.


Long-term survival of patients with glioblastoma multiforme (GBM).

This article has analyzed survival patterns and found that once a GBM patient survives for

2.5 years after diagnosis, the chances of dying each quarter year go way down.


Pseudoprogression: relevance with respect to treatment of high-grade gliomas

This article adopts an operational definition of pseudoprogression in high-grade gliomas

laid down by the Response Assessment in Neuro Oncology Working Group wherein either

the index (i.e. target) lesion stabilizes or diminishes in size on continued post-radiation

(temozolomide) therapy as determined by follow-up radiologic imaging.


The impact of enrollment in clinical trials on survival of patients with

glioblastoma.

Very important article.. scientists have been saying this this for years: Patients dosignificantly (live 30% longer) better in clinical trials even if they are assigned to the control

group. They are taken care of better.




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Hypofractionated Radiotherapy and Stereotactic Boost with Concurrent

and Adjuvant Temozolamide for Glioblastoma in Good Performance Status

Elderly Patients - Early Results of a Phase II Trial.

This study shows that for elderly GBM patients (65-87 years old), it may be possible to cut

the number of radiation treatments in half - to 15 visitis in 3 weeks from 30 visits in 6 weeks,

and get about the same results. Of course, the results either way aren't good enough and it

might be best to try a clinical trial of just about anything. However, if you are going to use the

standard treatment, saving 15 sessions will make a big difference in quality of life for those 3

weeks.

External-beam Radiotherapy (EBRT) and Cyber-Knife stereotactic radiosurgery (SRS)

treatment plans for a patient who received 40Gy in 15 fractions to FLAIR for the first course

followed an SRS boost to T1 Enhancement at a total dose of 24Gy delivered in 3 fractions.

Shown are the (A) axial, (B) sagittal, and (C) coronal views of the EBRT treatment plans and

the (D) axial, (E) sagittal, and (F) coronal views of the Cyber-Knife SRS treatment plans.




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TEMODAL

Indication

TEMODAL (temozolomide) is indicated for the treatment of adult patients with newly diagnosed glioblastoma

multiforme concomitantly with radiotherapy and then as maintenance treatment.

Selected Important Safety InformationTEMODAL is contraindicated in patients who have a history of hypersensitivity (such as urticaria, allergic

reaction including anaphylaxis, toxic epidermal necrolysis, and Stevens-Johnson syndrome) to any of its

components, or to DTIC.

Patients treated with TEMODAL may experience myelosuppression including prolonged pancytopenia, which

may result in aplastic anemia, which in some cases has resulted in a fatal outcome. In some cases, exposure to

concomitant medications associated with aplastic anemia including carbamazepine, phenytoin, and

sulfamethoxazole/trimethoprim complicates assessment. Geriatric patients and women have been shown in

clinical trials to have a higher risk of developing myelosuppression. Cases of myelodysplastic syndrome and

secondary malignancies, including myeloid leukemia, have also been observed.

Prophylaxis against Pneumocystis carinii pneumonia is required for all patients receiving concomitant

TEMODAL and radiotherapy for the 42-day regimen. There may be a higher occurrence of PCP when

temozolomide is administered during a longer dosing regimen. However, all patients receiving temozolomide,

particularly patients receiving steroids, should be observed closely for the development of PCP regardless of

the regimen.

TEMODAR can cause fetal harm when administered to a pregnant woman. In nursing women, a decision should

be made whether to discontinue nursing or to discontinue TEMODAL, taking into account the importance of the

drug to the mother. The safety and effectiveness of TEMODAL in children have not been established.

As bioequivalence between TEMODAL Capsules and TEMODAL for Injection has been established only when

TEMODAL for Injection was given over 90 minutes, infusion over a shorter or longer period of time may result

in suboptimal dosing. Additionally, the possibility of an increase in infusion-related adverse reactions cannot be

ruled out.

TEMODAL Capsules should not be opened or chewed. If capsules are accidentally opened or damaged, rigorous

precautions should be taken with the capsule contents to avoid inhalation or contact with the skin or mucous

membranes.

Caution should be exercised when administered to those with severe hepatic or renal impairment.The adverse event profile was similar in patients 65 years.

The most common adverse reactions in clinical studies in the Concomitant Phase (Radiotherapy + TEMODAL)

and the Maintenance Phase (TEMODAL alone), respectively, were alopecia 69%, 55%; fatigue 54%, 61%; nausea

36%, 49%; vomiting 20%, 29%; anorexia 19%, 27%; headache 19%, 23%; rash 19%, 13%; constipation 18%, 22%;

with the following important adverse events also reported: convulsions 6%, 11% and thrombocytopenia 4%,

8%.

Of these adverse events, those grade > 3 in clinical studies in the Concomitant Phase (Radiotherapy +

TEMODAL) and the Maintenance Phase (TEMODAL alone), respectively, were fatigue 7%, 9%; nausea 1%, 1%;

vomiting

Documents

NOSC Newsletter 4Feb 2013 2(1)