Capacity building for pediatric neuro-oncology in Pakistan- a project by my child matters program of Foundation S.

Introduction: Initiated in June 2019, this collaborative effort involved 15 public and private sector hospitals in Pakistan. The primary objective was to enhance the capacity for pediatric neuro-oncology (PNO) care, supported by a My Child Matters/Foundation S grant. Methods: We aimed to establish and operate Multidisciplinary Tumor Boards (MTBs) on a national scale, covering 76% of the population (185.7 million people). In response to the COVID-19 pandemic, MTBs transitioned to videoconferencing. Fifteen hospitals with essential infrastructure participated, holding monthly sessions addressing diagnostic and treatment challenges. Patient cases were anonymized for confidentiality. Educational initiatives, originally planned as in-person events, shifted to a virtual format, enabling continued implementation and collaboration despite pandemic constraints. Results: A total of 124 meetings were conducted, addressing 545 cases. To augment knowledge, awareness, and expertise, over 40 longitudinal lectures were organized for healthcare professionals engaged in PNO care. Additionally, two symposia with international collaborators and keynote speakers were also held to raise national awareness. The project achieved significant milestones, including the development of standardized national treatment protocols for low-grade glioma, medulloblastoma, and high-grade glioma. Further protocols are currently under development. Notably, Pakistan's first pediatric neuro-oncology fellowship program was launched, producing two graduates and increasing the number of trained pediatric neuro-oncologists in the country to three. Discussion: The initiative exemplifies the potential for capacity building in PNO within low-middle income countries. Success is attributed to intra-national twinning programs, emphasizing collaborative efforts. Efforts are underway to establish a national case registry for PNO, ensuring a comprehensive and organized approach to monitoring and managing cases. This collaborative initiative, supported by the My Child Matters/Foundation S grant, showcases the success of capacity building in pediatric neuro-oncology in low-middle income countries. The establishment of treatment protocols, fellowship programs, and regional tumor boards highlights the potential for sustainable improvements in PNO care.

Demographic variables of Vestibular schwannoma's patients presented in Radio Surgical out- patient department of Cyberknife Robotic Radiosurgery, JPMC Karachi.

OBJECTIVE: To determine the age, gender and sites of vestibular schwannoma cases using contrast-enhanced magnetic resonance imaging. METHOD: The retrospective descriptive study was conducted at the Department of Cyberknife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre, Karachi, and comprised data of patients with vestibular schwannomas from January 2016 to September 2018. Some of them were histologically proven and rest were radiologically proven. Cases were reviewed on contrast-enhanced magnetic resonance imaging of the brain. Statistical Package for the Social Sciences version 20 (SPSS) was applied. RESULTS: Of the 500 cases of vestibular schwannomas identified with 515 tumours, 300(60%) were males and 200(40%) were female. The overall mean age was 42.7±14.4 years (range: 17-85 years). Out of 515 tumours, the commonest site was the right cerebellopontine angle in 340(66%) cases. There were 15(3%) cases of radiologically-proven neurofibromatosis type 2. Overall, 490(98%) patients had main clinical complaint of progressive unilateral hearing loss, 5(1%) had vertigo and 5(1%) had facial palsy. CONCLUSIONS: Vestibular schwannomas were found to be more common among adults, with male preponderance and right cerebellopontine angle being the common site.

Cyberknife Radiosurgery in Hepatocellular Carcinoma.

OBJECTIVE: To determine the outcome of Stereotactic Body Radiation Therapy (SBRT) and its prognostic factors among hepatocellular carcinoma (HCC) patients. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Radiology and Cyberknife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan from 1st July 2019 to 31st August 2020. METHODOLOGY: All patients of either gender age 18 years and above presenting with pathological confirmation of HCC, ECOG performance status of ≤2 and child Pugh A or B were consecutively enrolled. Progression of >20% was defined as progressive disease (PD). SBRT was performed using the Cyberknife. Clinical outcome was measured in terms of progression free survival. Moreover, radiation induced toxicity was also observed along with other predictor variables.            Results: Of 52 patients, the median age was 58 (53-59) years. There were 42 (80.8%) males and 10 (19.2%) females. All patients were alive at 3 months, i.e. 52 (100%). However, at 6 months, 49 (94.2%) were alive, at 9 months, 38 (73.1%) patients were alive while at 1 year, 24 (46.2%) patients were alive. A significant association was observed for survival at 6 months and ECOG performance status score (p-value 0.036), survival at 9 months and AFP (p= 0.003), survival at 1 year and age (p = 0.019), survival at 1 year and HBV (p = 0.001), and survival at 1 year and previous treatment (p = 0.010). Moreover, none of the patients reported complications / radiation induced liver toxicity. CONCLUSION: A higher efficiency of SBRT was found among HCC patients attending Radiology Department. Key Words: Stereotactic body radiation therapy, Hepatocellular carcinoma, Toxicity, Survival.

Malignant head and neck tumours in Radiology Department JPMC Karachi -- a tertiary care experience.

OBJECTIVE: To study age, gender and sites of malignant head and neck tumours on contrast-enhanced computed tomography and to elucidate its role. METHODS: The retrospective study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and comprised data of patients with histologically proven malignant head and neck tumours reporting from February 2013 to February 2014. Contrast enhanced computed tomography with puffed cheek technique was done in cases of oral cancer, while routine contrast computed tomography was done in cases of other head and neck tumours. SPSS 19 was used for statistical analysis. RESULTS: A total of 100 biopsy-proven cases of malignant tumours comprised the study sample. The male: female ratio was 1.5:1 with an overall mean age of 46.4±16-76 years. . The most common histopathologically proven tumour was squamous cell carcinoma affecting oral mucosa 43(43%), followed by larynx 27(27%) and pharynx 10(10%) . CONCLUSIONS: Oral squamous cell carcinoma was the commonest tumour. Compute tomography scan with puffed cheek technique played a beneficial role in locating the site of primary tumour.