BRAIN TUMOR PROGRAM Co-Chairs: Dr. R. Brownstone & Dr. S. Kirby Linda Clarke, Research Coordinator

Linda Clarke

Most neurosurgeons are involved in the care of patients with brain and spinal tumours. In addition, the multidisciplinary nature of our program is reflected in the patient management conferences of the Neuro-oncology Site Team of Cancer Care Nova Scotia, chaired by Dr Brownstone and Dr Kirby (Neurology). These weekly conferences involve neurosurgeons, medical neurooncologists, radiation neurooncologists, neuropathologists, nurses, and trainees of each of these disciplines. In addition to patient management recommendations, this team organizes visiting speakers and rounds, and is responsible for the development of guidelines for the management of patients with brain and spinal tumours.  Research: Prospective epidemiology Brain Tumour Database continues-1560 patients entered. Deep Vein Thrombosis/ Pulmonary Embolism: Patient Information Pamphlet and Research Project on DVT/PE. CE5 - Low Grade Glioma Trial is now accruing patients. This includes registration while stable and randomization to either radiation treatment or chemotherapy with Temozolomide at progression. Prodige study - phase III clinical trial for patients with high grade glioma to determine the efficacy of low molecular weight heparin in thromboembolism prevention. 1231-Iodo-Alpha-Methyl Tyrosine SPECT study: Together with Dr S Burrell in the Department of Diagnostic Imaging (nuclear medicine), we have funding for a project in which we will use 123IMT to study patients with metastatic brain tumours. We are awaiting approval of the compound, which has not yet been used in Canada. Accomplishments: Brain Tumour Spring Sprint Fundraiser raised $21,000 Third successful Patient Information Day - over 100 patients and family members attended with presentations from visiting speakers, Dr. N. Laperriere, Radiation Oncology, Toronto and Dr. D. MacDonald, Neuro-oncologist, London, ON, and local specialists including, Dr. D. McNeely, Dr. R. Macaulay, Dr. R. Rutledge and Dr. Robert Adams (Moncton) Federal MP -Bill Casey for Cumberland/Colchester/Musquodoboit Valley debated a Private members motion - M-235 in the House of Commons to support national Brain Tumour Data Collection, Analysis and Reporting. Hiring of Data Entry Clerk for updating treatment information Dr. Mary MacNeill, Medical Oncologist joined our team Future Directions: we will continue to be involved in multi-centre trials we will pursue investigator-initiated trials we will expand our neuropathology capabilities with the introduction of fluorescent in situ hybridization techniques we will complete our Neuro-oncology guidelines Team Members: Dr. Rob Brownstone, Division of Neurosurgery, Co-Chair CNS CST Dr. Sarah Kirby, Department of Medicine, Neurology, Co-Chair CNS CST Dr's Simon Walling, Dan McNeely, Sean Christie, Ivar Mendez, Ian Fleetwood, William Howes, Renn Holness, Division of Neurosurgery Linda Clarke, Neurosurgery, RN, Research Coordinator Carole-Ann Miller, Neurosurgery, SNP Dr. Rob Macaulay, Department of Pathology & Laboratory Medicine Dr. Alex Easton, Department of Pathology & Laboratory Medicine Dr. Dorianne Rheaume, Department of Radiation Oncology Dr. Liam Mulroy, Department of Radiation Oncology Dr. Mary McNeill, Department of Medical Oncology Marlene Sellon, Pharmacist Colleen Kelly, RN, Radiation Oncology Trudy Gordon, RN, Medical Oncology Lynda Eastham, RN, Radiation Oncology Ellen Crawley, RN, Radiation Oncology

THE ATLANTIC LATERAL SKULL BASE PROGRAM

Dr. Simon Walling
Dr. Renn Holness

Linda Clarke, Research Coordinator

The Atlantic Lateral Skull Base Clinic is a collaborative initiative bringing together Neurootology (Division of Otolaryngology), Neurosurgery and the Stereotactic Radiotherapy Group.

The clinic provides coordinated care to patients with a range of lateral skull base tumours including vestibular schwannomas, other cerebellopontine angle tumours, lesions of the petrous apex and jugular foramen. Patients are carefully followed, and tumours are assessed for growth before intervention. Over 50% of our vestibular schwannomas are treated with a conservative “watchful waiting” approach.

When treatment is required, the experts on our teams provide a full range of treatment options, including surgery, and Stereotactic Radiation Therapy (SRT).

Monthly clinics are held at the Halifax Infirmary. Regular team meetings provide an opportunity to review patients discuss the direction of program development and the planning of research initiatives.

 Research:

• The program has established an extensive database capturing approximately 320 patients including 250 patients with vestibular schwannoma.
• Vestibular Schwannoma: How Much Residual Hearing is Useful?
• Acoustic Neuroma Management: Conservative Management vs. Stereotactic Radiotherapy and Subsequent Hearing Preservation at 6 Months and 1 Year
• Hearing Changes in Conservatively Treated Non-Growing Vestibular Schwannoma Patients.

Events & Accomplishments:

• Comprehensive Audiogram database- a unique program to monitor changes in serial hearing evaluations
• Revision of the clinic patient assessment tool
• Acoustic Neuroma Association of Canada Conference/AGM was held in Halifax, June, 2007 with presentations by Dr. Manohar Bance and other local specialists
• Quality of Life assessments introduced to clinic visits assessing hearing, tinnitus and dizziness handicap
• Four successful multidisciplinary clinics were held. Patients were seen by the Stereotactic radiation team as well as Neurosurgery and Neuro-otology in one visit.
• Members of the Skull Base Team attended and presented at the 5 th International Conference on Vestibular Schwannoma and other CPA lesions in Barcelona Spain, June 2007

 Future Directions:

• Monthly combined Skull Base and SRT clinics in 2008
• Database refinement
• Appraisal of the need for an Auditory Brainstem Implant program

Program Goals:

• To offer a single centre, multidisciplinary approach
• To be an internationally recognized centre for lateral skull base lesions
• To be at the forefront of clinical research in lateral skull base lesions
• To maintain a detailed database allowing critical appraisal of current treatment strategies.
• To be sensitive to new developments in our specialty allowing us to be critical of our practice and outcomes.
• To change our practice in light of evidence based research

Team Members:

Dr. Simon Walling, Division of Neurosurgery, Dept of Surgery

Dr. Renn Holness, Division of Neurosurgery, Dept of Surgery

Dr. Manohar Bance, Otologist, Division of Otolaryngology, Dept. of Surgery

Dr. David P. Morris, Otologist, Division of Otolaryngology, Dept. of Surgery,

Linda Clarke, RN, Program Coordinator

Belinda Nicoll, Administrative Assistant

Jean Lessell, Administrative Assistant

Eleanor Young, Administrative Assistant

Jackie Seagers, Clinic Assistant

Team Collaborators:

The Stereotactic Radiosurgery Group

Dr. Ian Fleetwood, Division of Neurosurgery, Dept. of Surgery

Dr. Dorianne Rheaume, Department of Radiation Oncology

Dr. Liam Mulroy, Department of Radiation Oncology

Nova Scotia Hearing and Speech

THE HALIFAX NEUROPITUITARY PROGRAM Dr. David Clarke
Dr. Renn Holness
Dr. Ian Fleetwood

Linda Clarke, Research Coordinator

This program, unique in Canada, provides comprehensive care to patients with pituitary and sellar region tumours. Multidisciplinary biweekly clinics that involve collaboration with the Stereotactic Radiosurgery Group, and surgical collaboration with Otolaryngology to develop endoscopic surgery, ensures comprehensive assessment, state of the art treatment and coordinated follow-up.

 Program Goals:

• To deliver excellence in coordinated and effective patient care
• To educate health care providers, patients and families
• To improve patient care through research

Research:

We continue to expand the Neuropituitary Database, with over 500 of the approximately 900 patients we follow now entered. Several research projects are underway:

• The role of visual field testing in the follow-up care of patients with pituitary adenomas
• Rate of re-growth of non-functioning pituitary adenomas
• Visual fields are preserved in acromegalic patients treated with SRT, I. Fleetwood, A. Imran, E. Ur, D. Clarke, L. Clarke, D. Rheaume, and L. Mulroy. CNSF Meeting, Edmonton AB, June 2007
• Short Term Outcome of Stereotactic Radiation Therapy in Patients with Acromegaly. A.Imran, D.B.Clarke, C.OConnell, L.Mulroy, D.Rheaume, I.Fleetwood, E.UR, T.Ransom, Endocrine Society Meeting, Toronto, ON, June 2007
• Managing prolactin-secreting adenomas during pregnancy, A.Imran, E. Ur, D.B. Clarke, Can Fam Physician; 53:653-658, 2007

 Events & Accomplishments:

• Atlantic Endocrine Society Meeting held June 16, 2007 in Wolfville, NS, with a half day focused on the management of pituitary tumours. Dr. David Clarke spoke on “Surgical Approaches to Pituitary Tumours”
• The Halifax Neuropituitary Program (HNPP) Pituitary/Parasellar Tumour Classification system was implemented as a standard evaluation tool
• Endoscopic-assisted transsphenoidal surgery for pituitary and sellar region tumours continues to be developed with the collaboration of Otolaryngology (Dr. E. Massoud)
• The Acromegaly Support Group facilitated by Lisa Tramble and Paula Sinclair is the only group of its kind in Canada. Held biannually, patients from all of the Maritime Provinces attend. Dr. Clarke spoke at the 2007 spring meeting: “Surgical Management of patients with Acromegaly”
• Extensive revision of our patient database, coordinated by Linda Clarke

Future Directions:

• Continue to expand our research initiatives
• Implement a volumetric software program with our current database to enhance our ability to monitor tumour growth

 Team Members:

• Dr. David B. Clarke (Neurosurgery)
• Dr. Renn O. Holness (Neurosurgery)
• Dr. Ali Imran (Endocrinology)
• Dr. Ehud Ur (Endocrinology)
• Linda Clarke, RN (Neurosurgery)
• Lisa Tramble, RN (Endocrinology)
• Paula Sinclair, RN (Endocrinology)
• Eric Grouse, Pituitary Clinic Coordinator (Neurosurgery/Endocrinology)

The Stereotactic Radiosurgery Group

• Dr. Ian Fleetwood (Neurosurgery)
• Dr. Dorianne Rheaume (Radiation Oncology)
• Dr. Liam Mulroy (Radiation Oncology)

Otolaryngology

• Dr. E. Massoud (Otolaryngology)

Team Collaborators:

• Neuroradiology
• Nova Scotia Eye Centre