Evaluation of the Pediatric Neuro-Oncology Resources Available in Chile

Abstract

Purpose: Pediatric neuro-oncology resources are mostly unknown in Chile. We report the human and material resources available in Chilean hospitals providing pediatric neuro-oncology services.

Methods: A cross-sectional survey was distributed to 17 hospitals providing pediatric neuro-oncology services (Programa Infantil Nacional de Drogas Antineoplásicas [PINDA] hospitals, 11; private, 6).

Results: Response rate was 71% (PINDA, 8; private, 4). Pediatric neuro-oncology services were mainly provided within general hospitals (67%). Registries for pediatric CNS tumors and chemotherapy-related toxicities were available in 100% and 67% of hospitals, respectively. CNS tumors were treated by pediatric oncologists in 92% of hospitals; none were formally trained in neuro-oncology. The most used treatment protocols were the national PINDA protocols. All WHO essential medicines for childhood cancer were available in more than 80% of the hospitals except for gemcitabine, oxaliplatin, paclitaxel, and procarbazine. The median number of pediatric neurosurgeons per hospital was two (range, 2-6). General neuroradiologists were available in 83% of the centers. Pathology specimens were sent to neuropathologists (58%), adult pathologists (25%), and pediatric pathologists (17%). Intensity-modulated radiotherapy, conformal radiotherapy, and cobalt radiotherapy were used by 67%, 58%, and 42% of hospitals, respectively. Only one private hospital performed autologous hematopoietic cell transplant for children with CNS tumors.

Conclusion: A wide range of up-to-date treatment modalities are available for children with CNS tumors. Our survey highlights future directions to improve the pediatric neuro-oncology services available in Chile such as the expansion of multidisciplinary clinics, palliative care services, long-term cancer survivorship programs, dedicated clinical research support teams, establishing standardized mechanism for sending pathologic specimen for second opinion to international specialized centers, and establishing specialized neuro-oncology training program.

FIG 1

The map of Chile demonstrating the location of all hospitals providing pediatric neuro-oncology services. Map attribution: Chile location map Wikimedia Commons CC BY 1.2 version, map was modified by the authors. Source: https://commons.wikimedia.org/wiki/File:Chile_location_map.svg.

FIG 2

The availability of various chemotherapeutic agents in the participating hospitals. GC-SF, granulocyte colony-stimulating factor; MEK, mitogen-activated protein kinase kinase.

FIG 3

The histopathologic stains available in the participating hospitals. ATRX, α-thalassemia/mental-retardation-syndrome-X-linked gene; EMA, Epithelial membrane antigen; GFAP, glial fibrillary acidic protein; HCGβ, beta-human chorionic gonadotropin.

FIG 4

The radiotherapy modalities available in the participating hospitals. 3D, three dimensional; VMAT, volumetric-modulated arc radiotherapy.

FIG 5

The neuroimaging modalities available in the participating hospitals. CT, computed tomography; MRI, magnetic resonance imaging.

FIG 6

The available support and ancillary services in the participating hospitals.