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.