Paediatric Neuro-Oncology 1 st April 2014 - 31 st March 2015 Kim - PowerPoint PPT Presentation

Paediatric Neuro-Oncology 1 st April 2014 - 31 st March 2015 Kim Phipps Great Ormond Street Hospital for Children NHS Trust

New Brain Tumours

New Brain Tumours 2005 - March 2015 100 90 80 70 60 50 40 30 20 10 0 2005 2006 2007 2008 2009 2010 2011 2012 2013/14 2014/15

New brain tumours Apr 2014-Mar 2015 Demographic details Ethnic Group Sex Female : 42 patients 43 (48%) Patients : White Male : 47 patients 46 (52% Patients : Non-White Nb. Excluding foreign private patients from abroad (N=8) 42(52%) Patients : White 39(48%) Patients : Non-White

New brain tumours Apr 2014-Mar 2015 : Age Groups 60 50 40 30 20 10 0 Under 1yr 1yr - <3yrs 3yrs - <13 yrs 13ys-<16 yrs >16yrs

New patients under 3yrs at diagnosis: Apr 2014-Mar 2015 30 25 20 1-3YRS 15 UNDER 1YR 10 5 0 2005 2006 2007 2008 2009 2010 2011 2012 2013/14 2014/15

New patients under 3yrs at diagnosis including 2 nd referrals : Apr 2014-Mar 2015 35 30 25 20 1-3YRS UNDER 1YR 15 10 5 0 2005 2006 2007 2008 2009 2010 2011 2012 2013/14 2014/15

New brain tumours by region 2009- March 2015 60 50 40 2009 2010 2011 30 2012 2013/14 2014/15 20 10 0 Abroad * Eastern London SouthEast Other

New brain tumours Apr 2014-Mar 2015 : by diagnosis OTHER CNS TUMOURS GERMINOMA/GCT/TERATOMA CHOROID PLEXUS TUMOURS GANGLIOGLIOMA DNET/GLIONEURONAL under 1yr CRANIOPHARYNGIOMA 1- 3yrs OTHER GLIOMA 3-12yrs BRAINSTEM GLIOMA >13yrs HIGH GRADE GLIOMA* EPENDYMOMA ATRT MEDULLOBLASTOMA** 0 5 10 15 20 25 30 *Excludes brainstem ** Includes one Pineoblastoma

New brain Glioma Apr 2014-Mar 2015 : site 14 12 10 8 > 13yrs 3-12yrs < 3yrs 6 under 1yr 4 2 0 HIGH GRADE* BRAINSTEM** OPTIC PATHWAY CEREBELLAR OTHER SITES

New brain tumours Apr 2014-Mar 2015 : Treatment pathway NONE(WAIT & SEE) CHEMO ONLY RT & CHEMO RT ONLY UNDER 1yr SURG & PALLIATIVE CARE 1yr-3yr SURG GOS TF OTHER 3yr-12yr 12yr-16yr SURG & RT >16yr SURG & PROTONS SURG CHEMO & RT SURG & CHEMO SURG ONLY 0 5 10 15 20 25 30 35

New brain tumours Apr 2014-Mar 2015 : Treatment summary 80 70 60 50 40 30 20 10 0 SURGERY CHEMO RT PROTONS

New brain tumours Apr 2014-Mar 2015:– method of diagnosis Radiological & Clincal 19% Histological 81%

2 nd Referrals Brain tumours April 2014-March 2015

2 nd Referrals - Brain tumours April 2014-March 2015 16 14 12 10 8 6 4 2 0 2005 2006 2007 2008 2009 2010 2011 2012 2013/14 2014/15

Tumour group - 2 nd Referrals - Brain tumours April 2014-March 2015 Low Grade Glioma Anaplastic astrocytoma/DPIG ATRT Choroid plexus tumour 0 1 2 3

Age group - 2 nd Referrals - Brain tumours April 2014-March 2015 3 2 1 0 <1YR 1YR - 3YRS 3- 12 YRS >12 YRS

Reason for 2 nd Referral - Brain tumours April 2014-March 2015 Moved to our catchment area Management of recurrent/prog tumour Further managment of new tumour 0 1 2 3

2 nd Referral - Brain tumours April 2014-March 2015 Treatment summary 4 3 2 1 0 SURGERY ONLY SURGERY & PALLIATIVE CARE CHEMO ONLY WATCH & WAIT

Recurrent/progressive Brain Tumours

Recurrent/progressive Brain Tumours April 2014 – March 2015 80 70 60 50 40 30 20 10 0 2005 2006 2007 2008 2009 2010 2012 2013/14 2014/15

Brain tumour Recurrence/progression episode April 2014 – March 2015 45 40 35 30 25 20 15 10 5 0 1st 2nd 3rd 4th 5th 6th 7th

Recurrent/progressive Brain Tumours April 2014-March 2015 : Tumour Type OTHER GCT HIGH GRADE GLIOMA CRANIOPHARYNGIOMA LGG BRAINSTEM GLIOMA EPENDYMOMA ATRT PNET* 0 5 10 15 20 25 30

Recurrent/progressive Brain Tumours April 2014-March 2015 : Treatment Pathway NONE(WAIT & SEE) TF / OR TREATMENT OTHER UNIT CONTINUE WITH CURRENT THERAPY PROTONS CHEMO & PALLIATIVE CARE CHEMO ONLY RT & PALLIATIVE CARE RT & CHEMO AWAITING PLAN PALLIATIVE CARE ONLY SURG & INTRACYSTIC THERAPY SURG & PALLIATIVE CARE SURG & CHEMO & PALLIATIVE CARE SURG CHEMO & RT SURG & RT SURG & CHEMO SURG ONLY 0 5 10 15 20 Note: 71 patients had 88 episodes of progression/ recurrence resulting in a Change in treatment pathway. These 17 changes are included above.

Summary of Treatment Pathway: Brain tumour recurrence/progression Apr 2014 – Mar 2015 35 30 25 20 15 10 5 0 SURGERY CHEMOTHERAPY RADIOTHERAPY PROTONS PALLIATIVE CARE

Spinal Tumours

New Spinal Tumours : Apr 2014- Mar 2015 16 14 12 10 8 6 4 2 0 2005 2006 2007 2008 2009 2010 2011 2012 2013/14 2014/15

New Spinal Tumours : April 2014-March 2015 :Tumour Type Osteosarcoma Secreting GCT Meningioma grade 2 under 1yr Aneurysmal bone cyst 1- 3yrs 3-12yrs Peripheral PNET >13yrs Pilocytic Astrocytoma Neuroblastoma Schwannoma grade 1 0 1 2 3

New Spinal Tumours : April 2014- Mar 2015 Treatment pathway 8 7 6 5 4 3 2 1 0 NEUROSURGERY ONLY NEUROSURGERY & CHEMO NEUROSURGERY & TF GEN SURG CT GUIDED BIOPSY & CHEMO

Deaths

Deaths of patients April 2014-March 2015 35 30 25 20 15 10 5 0 2005 2006 2007 2008 2009 2010 2011 2012 2013/14 2014/15

2 nd Opinions

2 nd Opinions 1997 - 2015 160 140 120 100 80 60 40 20 0 1997 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013/14 2014/15

2 nd Opinions 2014/15 • 152 discussions on 116 patients • 65 external patients (71 discussions) • 51 Gosh patients - non neuro-oncology (Oncology and other teams) - (81 discussions)

Patient Discussions in MDT 2014/15

Patient discussions in MDT 2014/15 65 Neuro-oncology patients Internal Opinions 51 External Opinions 246

Patient discussions in MDT 2014/15 71 81 Neuro-oncology patients Internal Opinions External Opinions 1213

The End !