FORT LAUDERDALE, Fla--The panel preparing pediatric cancer guidelines
for the National Comprehensive Cancer Network (NCCN) faced a somewhat
different task than the adult cancer panels, since the development
of pediatric guidelines is much more of a national undertaking.
"There is interest on the part of the leadership of the Pediatric
Oncology Group (POG) and the Childrens Cancer Group (CCG) to try
to develop this as a national effort, and we at the NCCN are going
to cooperate in whatever way we can," said Richard O'Reilly,
MD, chairman of the pediatric guidelines panel, in his presentation
at the NCCN's first annual conference.
He noted that the NCCN guidelines effort is "particularly
exciting" because it will eventually include a system for
tracking their utility, including outcomes, compliance, and resource
utilization by different centers.
At the NCCN conference, Dr. O'Reilly, of Memorial Sloan-Kettering
Cancer Center, and panel member Ching-Hon Pui, MD, of St. Jude
Children's Research Hospital, presented the preliminary guidelines
for three pediatric cancers: acute lymphoblastic leukemia (ALL),
osteogenic sarcoma, and neuroblastoma.
Genetic alteration underlies every case of leukemia, and for that
reason, the leukemia guideline stresses the importance of genetic
studies in the diagnosis, Dr. Pui said.
Virtually all of the NCCN centers are performing cytogenetics
studies, he said. But the panel considers molecular studies even
more important, because "cytogenetically seemingly identical
lesions can be different at the molecular level, and also even
in the best hands, cytogenetic studies can be successfully performed
in only 80% to 90% of patients." Moreover, Dr. Pui said,
there are some very important abnormalities that can be identified
only by molecular studies.