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Recap of the 2018 Society for Neuro-Oncology Wilkins-Barrick International Symposium on Neuro-Oncology
August 31 - September 1, 2018, Lima, Peru
Rosdali Díaz/Diana Osorio

Thanks to the Society for Neuro-Oncology (SNO) through the International Outreach Committee and on behalf of Dr. Mark Bernstein, the Greg Wilkins-Barrick Chair in International Surgery at the University of Toronto and Dr. Antonio Chiocca, President of SNO, the Pediatric Oncologists of the National Institute of Neoplastic Diseases Dra. Rosdali Díaz and the Edgardo Rebagliati Martins National Hospital Liliana Vasquez and Ivan Maza had the opportunity to organize an International Scientific event aimed at the care of pediatric patients with Central Nervous System Tumors in Latin America, for which we counted on the mentorship from the Neuro Oncology Program at Nationwide Children's Hospital, through Drs. Diana S. Osorio and Jonathan L. Finlay. We also took advantage of this great event to continue to develop the Third Pediatric Neuro Oncology Symposium for Latin America (PLANO), which had its beginnings with GRAACC in Sao Paulo, Brazil.

The event took place on August 31 and September 1, 2018, uniting 21 globally recognized subspecialists in the fields of pediatric Neuro-oncology, Neurosurgery, Neuro-pathology, Radiation Oncology, Neuro-Radiology, Neuro-Rehabilitation, Palliative Care and Cancer Data Registry.  We began our session with a general overview about the current state of neuro-oncology in Latin America with a brief discussion about the available resources for neuro-oncology throughout Latin America and expanded on patient outcomes in countries like Peru and Chile which was given by local oncologists, Dr. Rosdali Diaz and Ximena Espinoza.  We proceeded with our educational program discussing the perils of delays in diagnoses seen not only in developing countries, but in developed countries as well.  We discussed ways of educating the general community to help prevent such delays including programs that originated in the UK known as “HeadSmart”.  This was a keynote address given by Dr. Ibrahim Qaddoumi from St. Jude.  Dr. Andres Morales from Hospital Sant Joan de Deu in Barcelona then provided a general overview of how to think about the different pediatric brain tumors in a very concise and practical way.  Dr. Arie Perry one of the authors of the 2016 WHO for CNS tumors discussed the general pathologic and molecular diagnosis of pediatric CNS tumors relevant to Latin America, he ended with a song he created to help recall some of the more common pediatric brain tumors (available on YouTube) and he received a standing ovation.  Chief of Pediatric Neurosurgery at Nationwide Children's Hospital Dr. Jeffrey Leonard discussed neurosurgical techniques not only pertinent to neurosurgeons but relevant for pediatric oncologists as well.  The goal was also to be able to encourage multidisciplinary involvement in patient brain tumor care across all disciplines.  Neuro-radiologist Dr. Diana Rodriguez from Nationwide Children's Hospital provided an in-depth look into neuro-imaging tailored to pediatric oncologists to be able to understand why different techniques are utilized and when a tumor is more likely to be low-grade vs. high-grade. Dr. Robert Keating Chief of Pediatric Neurosurgery at Children’s National DC discussed the prevention of cerebellar mutism for posterior fossa tumors, during lunchtime.

Globally-recognized pediatric neuro-oncologist, Dr. Eric Bouffet from Sick Kids in Toronto gave a proposal on how to enhance multidisciplinary efforts in Latin America further emphasizing the importance of teamwork and communication among the different subspecialists.  He has vast experience in global outreach in countries like Jordan, Pakistan, etc and was a perfect fit for this talk.   We then delved into the management of specific pediatric brain tumors.  For medulloblastoma, we divided them by age groups to highlight the important differences in their management.  As such, Dr. Stefan Rutkowski from Hamburg, Germany PI of the German-HIT radiation-avoidance protocols, discussed the management of infant medulloblastoma and tied in the current molecular understanding of this entity and made it relevant to Latin America.  While Dr. Amar Gajjar director of the Neuro-Oncology Division from St. Jude, gave an excellent and thorough discussion of the management of children older than 3-5 years with medulloblastoma.  Dr. Jonathan L. Finlay from Nationwide Children's Hospital is internationally-recognized for intracranial germ cell tumors and gave a comprehensive review of the management of this heterogeneous group of tumors.  Dr. Jeffrey Leonard ended with a session on the neurosurgical approaches to tumors in the pineal region. The day closed at 7:00pm after discussion of several, local clinical cases in the presence of the expert, multidisciplinary panel of speakers to provide their feedback.  We understood the audience especially liked this part seeing the various opinions from these experts.

During the second day we started at 8:00am with Dr. Roger Packer, director of the pediatric Brain Tumor institute from Children’s National DC discussing the management of pediatric low grade gliomas elaborating on the recent molecular advances and how these may or may not be clinically relevant for Latin America. Dr. Mark Kieran from Bristol Meyers Squibb former head of Pediatric Neuro-Oncology at the Dana-Farber Cancer Institute gave two remarkable talks on some of our poorer prognostic tumor entities: DIPG, high grade gliomas, ATRT and other CNS-Embryonal tumors.  Dr. Liliana Goumnerova, neurosurgeon at the Dana-Farber Cancer Institute discussed her experience with helping build a neuro-oncology program in Cairo, Egypt helping to provide an understanding of some of the challenges they faced and solutions making it one of the busiest cancer programs in the Middle East.  Dr. Murali Chitagumpala co-director of the Brain Tumor Program of Texas Children’s Hospital discussed the management of Ependymoma.  Dr. Ute Bartels from Sick Kids in Toronto, discussed the management of Craniopharyngioma.   We ended these sessions with a boxed lunch and discussion of local cases. Drs. Diana Osorio and Andres Morales moderated both days in English and Spanish to facilitate translation and highlight key educational.  The second half of the second day was split into three concurrent sessions, in the main room continuing with educational talks about neurocutaneous syndromes and other genetic conditions that can predispose children to CNS cancers and was given by Dr. Soumen Khatua section chief of Pediatric Neuro-Oncology at MD Anderson.  Followed by sessions regarding survivorship, palliative care, neuro-rehabilitation, abandonment rates in Latin America (specifically in Peru), and the importance of a cancer data registry.  In two other rooms we concurrently held 4.5 hour workshops on specific neurosurgical topics including local case discussions while the other room we split time between radiation oncology and neuropathology, each with didactics and case discussions.  The day closed at 7:00pm.

Ninety percent of our participants had free registration thanks to the support of our sponsors Nationwide Children’s Hospital, St. Jude Children's Research Hospital and Children’s National DC, as well as local sponsors who helped to make such an ambitious event possible.  There were 144 participants: 70 from Peru, 16 from Colombia, 16 from EEUU, 11 from Brazil, 12 from Chile, 5 from Argentina, 6 from Mexico, 2 from Ecuador, 2 from Canada, 1 from Germany, 1 from Costa Rica, 1 from Dominican Republic, and 1 from Nicaragua. With representation from 86 pediatric oncologists, 27 neurosurgeons, 15 radiotherapists, 4 pathologists, 2 radiologist, 1 geneticists, 3 neurologists, 6 fellows. One of the reasons for the success of this meeting was the experience and expertise of the speakers since they are world leaders in their respective subspecialties and the recommendations given were relevant to the resources and capabilities of low-to-middle income countries.

Additionally, we were able to record the sessions onto video and hope to make this available on the internet.  Again, we would like to express our immense gratitude to SNO and Dr. Mark Bernstein, Wilkin's-Barrick Chair in International Surgery at the University of Toronto, for having provided us with this magnificent learning opportunity for pediatric subspecialists from all over Latin America.  Thank you for supporting us in our desires to find ways to bridge and lessen the survival gap for children with CNS cancers in our countries.