CCCL launched the Retinoblastoma Program in August 2012 in collaboration with St. Jude Children’s Research Hospital in Memphis, TN, USA.

Retinoblastoma is an eye tumor occurring most commonly among infants (up to 2 years old), but also in children up to 10 years of age.

Early treatment of retinoblastoma can save the eye and can save vision, but it needs specialized techniques that can include monthly laser and thermal treatment of the eye tumors, while the child is under anesthesia. Such treatment is only available at specialized centers and can be done only by an experienced multidisciplinary pediatric ophthalmology and anesthesia team. If this treatment is not available, children with retinoblastoma may lose the whole eye, sometimes both eyes, and may lose their life if the tumor spreads.

However, with the right early treatment, children with retinoblastoma are cured of their tumors in more than 95% of cases and can keep their vision in more than 80% of cases.

Through this program, all children with retinoblastoma from Lebanon and the region (including Syria, Iraq, and others) have access to a unified standard-of-care treatment. Through collaboration with their doctors, CCCL can help ensure that these children get their diagnosis confirmed, their imaging tests done, and the complex and expensive focal eye treatments done at the CCCL, at no cost to the family.

Since its start in August 2012 till 2019, 84 children have benefited from this program (including patients receiving full treatment at AUBMC and the patients who are referred from collaborative centers; i.e. fully and not fully enrolled patients)

Central nervous system tumors are the most common solid tumors in children and a leading cause of mortality and morbidity worldwide. The management of such tumors is extremely complex. Surgery to remove the tumor is not always possible. Another reason that malignant brain tumors can be difficult to treat is because the blood-brain barrier prevents chemotherapy from entering the brain and reaching the tumor. To successfully manage and treat children with these tumors, it takes a team of practitioners specifically focused on this area.

Launched in July 2019, the Pediatric Neuro-Oncology program at CCCL is a first in Lebanon and the region, through which patient-centered multidisciplinary care is coordinated by subspecialists from a variety of disciplines:

• Pediatric neuro-oncology
• Pediatric neurosurgery
• Radiation oncology
• Neuropathology
• Pediatric neuro-radiology

Experts with the program have access to rich resources, such as:

• Access to the best available treatments to deliver personalized care for all tumor types (standard chemotherapy, molecular testing, and alternative drugs)
• State-of-the-art neurosurgical technologies
• Radiation therapy technologies that allow for the most precise delivery of radiation in an effort to spare normal brain tissue from the impact of radiation treatment.
• Access to other services as required including pediatric neurology, neuro-ophthalmology, psychology, endocrinology, nutrition and rehabilitation medicine.

Over the past two years, our institute has provided consultations and/or primary medical oncology care to over 120 patients with primary brain and spinal cord tumors.

The bone tumor and limb salvage program at CCCL was established in collaboration with St. Jude Children’s Research Hospital, Tennessee-USA. CCCL is currently considered the major referral center for such procedures in the region with patients being referred from multiple neighboring countries. This program ensures that individualized treatment plans are made for each child with a bone tumor, with the goals of curing the cancer, while preserving the limb and its function whenever possible. Our specialized orthopedic surgeons, microvascular surgeons, radiation oncologists, radiologists, pathologists, and pediatric oncologists all work as a team to formulate the most appropriate plan for each patient. Limb salvage procedures performed at our center include placement of expandable prostheses, which allows limb elongation during growth and minimizes the need for follow up surgeries. Other procedures routinely used include standard prosthesis placement, use of bone allograft, autograft of specific bones, or radiation therapy, and the best modality is decided upon by a multidisciplinary team in a patient-centered setting.

The Leukemia Program was launched by CCCL, in July 2014 in collaboration with St Jude Children’s Research Hospital in Memphis, TN, USA.

Leukemia is a malignant progressive disease. Acute Lymphoblastic Leukemia (ALL) is the most common in children between the ages of 2 and 4 years while Acute Myelogenous Leukemia (AML) is the second most common type of leukemia in children.

Both types of acute leukemia need to be treated as soon as they are diagnosed, with the goal of inducing a remission. Analysis of the presence of minimal remaining tumor cells after chemotherapy, called Minimal Residual Disease or MRD, is essential for proper planning of treatment to prevent tumor recurrence. Through the leukemia program, the expertise of the CCCL oncologists and AUBMC hematopathologists is shared with other doctors who refer their patients for diagnostic and MRD studies.

Through this program, any child suspected to have leukemia can be referred by pediatric hematologists-oncologists, to get their diagnosis confirmed and their tests done at CCCL at no cost. Patients’ treatment planning is then performed through collaboration with the patient’s primary physician.

Since its start and up to 2019, 269 patients have benefited from the leukemia program, helping deliver an accurate diagnosis for children with leukemia who are being treated outside CCCL.

The Hodgkin Lymphoma Program was launched by the CCCL, in August 2014 in collaboration with St. Jude Children’s Research Hospital in Memphis, TN, USA.

Hodgkin lymphoma is a relatively common malignancy in the pediatric population, constituting approximately 40% of all lymphomas presenting during childhood. It is the most common malignancy in adolescents.

Following the right treatment, children with Hodgkin Lymphoma are cured in more than 90% of cases.

Through this program, all children suspected to have Hodgkin Lymphoma present to our center for full coverage, or partial coverage while referred by a pediatric oncologist, to get their diagnosis confirmed and their tests and radiotherapy done at the CCCL at no cost.

Patients’ treatment planning is coordinated through collaboration with the patient’s primary physicians for partially enrolled patients.

Since its start and up to 2019, 81 patients benefited from the Hodgkin Lymphoma Program.

The Fellowship Program is a three-year subspecialty residency in Pediatric Hematology-Oncology at the CCI, under the auspices of the GME (Graduate Medical Education) program at AUBMC. This residency provides an understanding of the patho-physiology of pediatric hematologic and oncologic disorders and competence in the clinical diagnosis and management of these disorders. Training occurs in the CCI out and in-patient facilities at AUBMC. The primary objective of this program is to train medical subspecialists to serve in Lebanon and neighboring countries in treatment of children with cancer and hematologic disorders. During fellowship, trainees are also offered a one-month rotation at St. Jude Children’s Research Hospital in Memphis, TN, USA.

A prerequisite for entry into the Fellowship Program at CCI/AUBMC would be the satisfactory completion of an accredited pediatric residency program or other training judged suitable by the program director and the AUBMC GME office. A resident must have completed the equivalent of 3 years of residency in Pediatrics. For application, please open the following link: https://www.aub.edu.lb/fm/gme/Pages/ApplicationForms.aspx

Pediatric Cancer Research Program & Data Management Unit

To constantly generate data for review and improvement of cancer care delivery, a Pediatric Cancer Research Program and a Data Management Unit have been established in 2012.

The data management unit formally evaluates the characteristics, treatment, and outcome of all children with cancer treated at our center. It helps identify types of cancers encountered in Lebanon and assures quality improvement by periodic assessment of quality and outcome measures in pediatric cancer care.

The registry has been established since August 2012; and up-to-date, it uses the St. Jude Children’s Research Hospital’s (SJCRH) provided Pediatric Oncology Networked Database (POND).

The patients seen at the center have been being entered prospectively since then and in retrospect back to 2002, when the center was inaugurated.

Currently, all pediatric oncology patients seen at the center, including program patients and consultations, are being entered in the registry, which now (2020) has a total of 2550 patients.

The patient status gets updated upon a change, and on a yearly basis, for patients who have ended treatment. Patient outcomes are being monitored biannually, to evaluate survival rates per disease and per treatment provided.

The cancer research program aims to study the specifics of childhood cancer and its treatment in Lebanon and the region. The goal is to better understand and fight pediatric cancer with demographic specific considerations.

The Data Management Unit currently includes a data manager and a clinical trials coordinator, and they provide support for all research activities at the center.

For publications by our oncologists about cancer treatment at CCCL, please check the below links:

• Dr. Raya Saab: https://www.aub.edu.lb/Pages/profile.aspx?MemberId=rs88
• Dr. Miguel Abboud: https://www.aub.edu.lb/Pages/profile.aspx?MemberId=ma56
• Dr. Samar Muwakkit: https://www.aub.edu.lb/Pages/profile.aspx?MemberId=sm03
• Dr. Nidale Tarek: https://www.aub.edu.lb/Pages/profile.aspx?MemberId=nt29
• Dr. Dima Hamideh: https://www.aub.edu.lb/Pages/profile.aspx?MemberId=dh19

For more information please check CCCL’s website: www.cccl.org.lb