Neuro-Oncology Program

Overview

Cincinnati Children's Hospital Medical Center is home to a multi-disciplinary, world-class group of physicians and researchers aimed at attacking the problem of brain and neural tumors, and working toward improving diagnosis, developing new therapies and improving long term outcomes for children. The Neuro-Oncology Program has a broad regional referral base, and follows approximately 800 patients with approximately 50-70 new patients per year.

The Neuro-Oncology Program at Cincinnati Children's Cancer Center offers a full spectrum of technologically advanced medical, surgical and diagnostic services for children and young adults with brain tumors and related diseases. The Cancer Center offers clinical trials of new pediatric brain tumor anticancer drugs, and is a lead institution of the National Cancer Institute's Pediatric Phase I Consortium and the new Neurofibromatosis Clinical Consortium.

Comprehensive Multidisciplinary Team Approach – Total Care for the Child and Family

At Cincinnati Children's, children with brain and neural tumors are cared for by a multidisciplinary team led by oncologists and stem cell transplant specialists with focused clinical expertise and laboratory research perspective in neural tumors and new anti-cancer therapies. Collectively, experts from numerous areas of specialty offer children and their families optimal care. The neuro-oncology program faculty features specialists with experience in the care of children with brain tumors including:

Neurosurgery (Kerry R. Crone, MD and Francesco T. Mangano, DO)
Oncology (John P. Perentesis, MD, FAAP, Lars Wagner, MD, James I. Geller, MD, and Brian Weiss, MD)
Neurology (Mary Sutton, MD)
Neuro-radiology (Blaise V. Jones, MD)
Radiation Oncology (John Breneman, MD and Ruth Lavigne)
Neuro-ophthalmology (Constance E. West, MD)
Physical Medicine and Rehabilitation (David W. Pruitt, MD)
Endocrinology (Susan R. Rose, MD and Meilan M. Rutter, MD)
Neuro-psychology (Drs. Marsh Nortz and Douglas Ris, PhD, ABPP-Cn)
Pathology (Lili Miles, MD)
Pain Management and Palliative Care (Norbert Weidner, MD , Mark Meyer, MD and Kenneth Goldschneider, MD, FAAP )
Core basic and translational research
- Neural tumors/Neurofibromatosis Biology and Molecular Therapies (Nancy Ratner, PhD)
- Gene Therapy and New Anticancer Drug Development (Yi Zheng, PhD, George Thomas, Punam Malik, MD, David Williams, Christof von Kalle, MD)
- Developmental Neurobiology (Masato Nakafuku MD, PhD, Kenneth J. Campbell, PhD, Alex Kuan, and others)
- Informatics (Bruce Aronow, PhD)

Teamwork to provide comprehensive patient care is also coordinated through the guidance of specialty nurse coordinators, and related staff sophisticated in social and family support, nutrition, play therapy, school re-entry and coordination with referring pediatricians and family doctors.

Neuro-Oncology Specialized Clinical Treatment and Research

The Neuro-Oncology Program of the Cancer Center offers state-of-the art care for children with newly diagnosed brain and spinal tumors, and is a major referral center for clinical research of the national Children's Oncology Group.

The Neuro-Oncology Program of the Cancer Center also is a referral center for the National Cancer Institute's new Pediatric Phase I Consortium, focusing on new anti-cancer drug development research initiatives for children. Dr. Perentesis serves on the national Steering committee for the consortium. Drs. Wagner and Geller are leading national clinical trials of novel chemotherapy combinations for patients with refractory or relapsed tumors. Additional key research and treatment options for patients with gliomas, medulloblastomas, and other brain tumors include new Cincinnati Children's initiatives in:

High dose therapy approaches with stem cell rescue for pediatric neural tumors
Gene therapy regimens
Anti-angiogenic (tumor blood vessel-targeted) therapy regimens
Targeted anticancer "small molecule" drugs

In addition, active research is being conducted in the Division of Experimental Hematology and Cancer Biology (Dr. Zheng, Acting Director) at Cincinnati Children's to develop new gene therapy approaches, vaccine-based, and targeted anti-cancer viruses for brain and other neural tumors.

Dr. Jones leads a nationally recognized center for diagnostic pediatric neuro-imaging, and his efforts are integrated into program initiatives for novel neurosurgical approaches, and in novel targeted anti-cancer therapies. Cincinnati Children's Neuro-Oncology Program imaging and functional neuronal-assessment capabilities include:

High Resolution Computed Tomography (CT)
Magnetic Resonance Imaging (3 Tesla MRI)
Dynamic MRI
Functional MRI and MR Tractography
MR Spectroscopy
Positron Emission Tomography (PET)-CT Hybrid Imaging
Magnetoencephalography (MEG)

Dr. Ris is leading a National Institutes of health-funded effort studying cognitive and neuropsychological outcomes of pediatric brain tumor therapy. Dr. Rose is an international expert on endocrine complications of pediatric malignancies and their therapy.

Neurosugical Innovation and the Cincinnati Children's BrainSUITE"

Cincinnati Children's is home to a dynamic oncologic neurosurgical initiative, led by Dr. Crone. In the Cincinnati Children's BrainSUITE", the world's most sophisticated technology creates three-dimensional maps, helping our neurosurgeons define a precise pathway through which to remove complex tumors from sensitive areas of the brain. During neurosurgical operations, computer generated images automatically match information from diagnostic tests with the patient's position on the operating table, showing the neurosurgeon the exact position of the surgical instruments in relation to the targeted brain tissue. A powerful MRI scanner is integrated into the BrainSUITE". This extraordinary technology offers the neurosurgeon unprecedented guidance to map the most accurate, safest pathway through the brain while preserving areas that control important functions such as speech and movement. Cincinnati Children's is the first children's hospital in the world to have this auto-registration system.

Dr. Crone is also nationally renown for pioneering endoscopic neurosurgery. Dr. Crone has recently developed an innovative minimally invasive procedure to operate on brain tumors deep in the brain that were previously thought to be inoperable (SMART surgery; Specialized Minimal Access Resection Techniques). The SMART surgery approach also holds great promise for the precise delivery of novel regional therapies.

Pediatric Radiotherapy Program

Cincinnati Children's is a national referral center for precision radiation therapy of brain and spinal tumors in children and young adults, through an integrated joint program with the Department of Radiation Therapy of the University of Cincinnati Barrett Cancer Center. Dr. Breneman directs the Pediatric Radiotherapy Program and also leads national activities in radiation therapy in the Children's Oncology Group. The center incorporates specialized pediatric care and pediatric anesthesia for children receiving radiation therapy. In addition to standard radiotherapy modalities, leading edge targeted treatments available include:

"Shaped beam" Stereotactic Radiation Therapy (Brainlab Novalis)
Tomotherapy - Helical Image-Guided Radiation Therapy (IGRT)
Intensity-Modulated Radiation Therapy (IMRT)

Neurofibromatosis (NF) Multidisciplinary Tumor Program

The Division of Human Genetics is home to a nationally-recognized Neurofibromatosis program, which follows 500 patients from 300 families, directed by Drs. Saal, Schorry, and Hopkin. The Neurofibromatosis clinic is recognized for clinical care of its large patient population, and also includes close interactions with the neurology division and an internationally recognized orthopedic surgeon specializing in the care of patients with NF, Drs. Crawford and Durrani.

The care of patients with Neurofibromatosis and tumor or malignancies is centered in the Oncology program, in the Neuro-Oncology / Neurofibromatosis Clinic. A multi-disciplinary neuro-oncology NF conference meets biweekly, and includes the NF physicians together with neuro-oncologists (Drs. Weiss, Perentesis, Sutton, Wagner) and neuro-radiologists. The Neuro-oncology program incorporates active therapy regimens designed for patients with NF and plexiform neurofibromas, malignant peripheral nerve sheath tumors, and optic pathway gliomas. Cincinnati Children's Cancer Program is also lead institution of the new NF Clinical Research Consortium, funded by the US Department of Defense. The NF Clinical Research Consortium is advancing care for children, adolescents, and young adults with NF-related tumors and neuro-cognitive challenges.

The NF group recently expanded with recruitment of Nancy Ratner to the Cincinnati Children's Cancer Program. Dr Ratner is an internationally-noted researcher in NF-related tumors, and Director of Neuro-Oncology Research. She is the director multiple research grant awards and Program Grant from the Department of Defense, National Institutes of Health, and the Multiple Sclerosis Society to study and develop new therapies for NF and brain tumors.

Retinoblastoma Multidisciplinary Program

Dr. James Augsburger of the joint University of Cincinnati and Cincinnati Children's Department of Ophthalmology, provides care for patients diagnosed with retinoblastoma at Cincinnati Children's through a coordinated effort with Dr. James Geller in the Cancer Center. The Division of Human Genetics provides genetic counseling services, and Dr. Pruitt provide Physical Medicine and Rehabilitation services through the Neuro-Oncology Program. The program offers specialized therapies to directly kill retinoblastoma tumors in the eye administered under special pediatric anesthesia including: