Children’s Neuro-Oncology Program Turns 10

from Practice Update, Summer 2005

In 1983, Nick Foreman, MD, was into the second year of his pediatric residency at Sheffield Children’s Hospital in the UK . A surgeon remarked to Foreman that no one knew what to do for children with brain tumors. At the time, there was not a single Pediatric Neuro-Oncologist in England .

“The results for pediatric brain tumor patients were disastrous in the early 1980s, not just in mortality rates. People not needing radiation were getting it,” Foreman said. “The main attitude and the reality was that brain tumors were not curable. We now cure two-thirds of our patients.”

After two fellowships, including one at the St. Jude’s Children’s Research Hospital in Memphis , Foreman arrived at Children’s in 1995 and launched its Neuro-Oncology program.

Today, he is one of just 35 pediatric neuro-oncologists spread amongst 30 states, is the clinical director of the Neuro-Oncology Program, and holds The Tanner Seebaum and Zachary Tschetter Chair in Neuro-Oncology at The Children’s Hospital.

Happy Birthday: The Gift of Life-Saving Treatment

Ten years from the program start, Foreman and his staff have much to celebrate with the program’s milestone anniversary: each year they treat more children with cancer, each year they save more kids with cancer, and each year their program expands.

Since 1995, the staff has treated 429 patients with brain tumors. Last year, 62 new patients were seen in addition to 38 consult cases. This is nearly double what the staff saw on an annual basis when they started 10 years ago.

At this time, the Neuro-Oncology team follows 300 patients and is recruiting for a third full-time neuro-oncologist. Dr. Julie Ley is the second of Children’s two pediatric neuro-oncologists. Ley started at Children’s as a fellow and has mastered a specialty in neurofibromatosis.

“Our survival curve keeps improving,” Foreman stressed. When he first started at Children’s about 10 percent of his patients beat their cancer. Today, more than 66 percent live.

Children’s, A National Center For Brain Tumors

Foreman assembled a comprehensive, multi-disciplinary, Neuro-Oncology Program at The Children’s Hospital which serves the Rocky Mountain region.

The Neuro-Oncology Program actively leads the way in developing new treatments for brain tumors. It is the lead institution in the Children’s Neuro-Oncology Consortium, which includes eight major institutions in the United States and develops innovative therapy for children with brain tumors carrying a poor prognosis. Additionally, The Children’s Hospital is a member of the Pediatric Oncology Experimental Therapeutic Investigators Consortium (POETIC) which introduces new therapies and regimens to patients.

Children’s has 24 open in-house or consortium protocols, including Phase I protocols, for Neuro-Oncology patients. The Children’s Hospital program holds national attention in ependymomas treatment. Foreman chairs the sub-committee for ependymomas for the Children’s Oncology Group. Recognized for its expertise in high-dose therapy, the group leads all ependymomas protocols and their development in the United States .

Foreman is involved in a study of ependymomas protocols which is into its second year. The study has 250 participants and is three times larger than any other study.

Dr. Foreman attends more than 90 percent of neurosurgical procedures being performed on the program’s patients. He ensures that samples are appropriately handled for research and discusses with the surgeon any operative difficulties. 

Bi-monthly the Neuro-Oncology core members meet to review patients, protocols and adverse events.  This meeting is attended by neurosurgery, radiology, pathology, radiation oncology, neurology and oncology. Participants include attending physicians, fellows, nurse practitioners, data managers, psychologists and the Neuro-Oncology coordinator.

Partners in Pioneering Treatments

The Neuro-Oncology Program has two important partners in the Neuro-Surgery Program and the Radiotherapy Division.

Michael Handler, MD, is the clinical director of Neuro-Surgery and is an active member of the Neuro-Surgery Committee of the Children’s Center for Cancer and Blood Diseases. Handler  holds the McMurry Seebaum Chair in Pediatric Neurosurgery.

Program Capabilities

There are six clinics per week solely for Neuro-Oncology patients on, or recently finished with, chemotherapy. By careful coordination with home-care, almost all chemotherapy for children with brain tumors is now given in the clinic. Long infusions and fluids are often completed at home.

One of the six clinics includes the long-term follow-up clinic once per month for Neuro-Oncology patients attended by neuro-oncology, neuro-surgery, radiation oncology, endocrinology, rehabilitation, neurology, ophthalmology, neuro-psychology, psychology, social work and a dietician.

Capabilities Summary

• Six clinics a week, including monthly multidisciplinary long term follow-up clinic
• A dedicated oncology outpatient unit with the ability to give outpatient chemotherapy
• A dedicated oncology inpatient unit of 16 beds
• A dedicated bone marrow transplant unit (six beds) which can be used to deliver high dose therapy to patients with brain tumors; staff is experienced in the unique problems of fluids and electrolytes balance in these patients
• A level IV pediatric intensive care unit with 16 beds
• An inpatient General Research Center program with six beds
• Access to the Cancer Center of the University Hospital if it is desired to include young adults in any trial
• A dedicated pharmacy unit to prepare oncological drugs