Clinical Profile, Patterns of Care and Outcomes of Childhood CNS Tumours in India

Paediatric CNS tumours are the third most common childhood malignancy in India. They account for 14% of all cancers in the 1–14 years age group. There is dearth of adequate prospective or retrospective studies about patterns of care and outcomes. There is male preponderance. Primitive Neuro-ectodermal tumours (PNET) are the most common histology followed by astrocytoma and other gliomas among children from 0 to 19 years. Surgery, radiotherapy, and chemotherapy are the main modalities of treatment. Available data points to underutilisation of radiotherapy in clinical practice due to the fear of non-compliance. Paediatric CNS tumours outcomes are different from adult brain tumours due to their aggressive histology, variable clinical presentations, delay in diagnosis, etc. There is also shortage of adequate multidisciplinary paediatric neuro-oncology units in the country. Future directions include setting up more dedicated paediatric neuro-oncology units, implementation of new 2022 WHO classification by adopting molecular testing across different histology’s, use of better radiation technology to prevent long term neurocognitive and other late effects and survivorship clinics to monitor for late effects and rehabilitate the childhood cancer survivors and, perhaps a registry. These issues are discussed in detail in this chapter

Discordance in Recommendation Between Next-Generation Sequencing Test Reports and Molecular Tumor Boards in India

PURPOSEAccurate understanding of the genomic and transcriptomic data provided by next-generation sequencing (NGS) is essential for the effective utilization of precision oncology. Molecular tumor boards (MTBs) aim to translate the complex data in NGS reports into effective clinical interventions. Often, MTB treatment recommendations differ from those in the NGS reports. In this study, we analyze the discordance between these recommendations and the rationales behind the discordances, in a non–high-income setting, with international input to evaluate the necessity of MTB in clinical practice.METHODSWe collated data from MTB that were virtually hosted in Chennai, India. We included patients with malignancies who had NGS reports on solid tissue or liquid biopsies, and excluded those with incomplete data. MTB forms and NGS reports of each clinical case were analyzed and evaluated for recommendation concordance. Concordance was defined as an agreement between the first recommendation in the MTB forms and the therapeutic recommendations suggested in the NGS report. Discordance was the absence of the said agreement. The rationales for discordance were identified and documented.RESULTSSeventy MTB reports were analyzed with 49 cases meeting the inclusion criteria. The recommendation discordance was 49% (24 of 49). Discordant recommendations were mainly due to low level of evidence for the drug (75% of cases).CONCLUSIONThe discordance between MTB and NGS vendor recommendations highlights the clinical utility of MTB. The educational experiences provided by this initiative are an example of how virtual academic collaborations can enhance patient care and provider education across geographic borders