The Children’s Cancer Center of Lebanon (CCCL) is comprised two facilities where patients undergo treatment: an outpatient facility and an inpatient one. The CCCL outpatient facility welcomes daily an average of 50 patients with their accompanying parent/guardian; and the CCCL inpatient facility has 17 fully furnished single rooms where patients spend an average stay of 5 nights.
The CCCL initiated and launched The National Bone Tumor Program in collaboration with St. Jude Children’s Research Hospital in Memphis, TN, USA.
This program allows all pediatric oncologists in Lebanon to use unified treatment protocols. It establishes a gold standard of care, thus ensuring optimal prognosis and cure rates.
The treatment of bone tumors require, in addition to chemotherapy, sophisticated surgery and/or radiation therapy (depending on the kind of tumor), which can be very expensive and difficult, especially in growing children where side effects in terms of bone growth have to be carefully considered.
Through this new program, all children across Lebanon, whether treated at the CCCL or other hospitals, now can get their diagnosis confirmed, their imaging tests done, and the complex and expensive surgery and/or radiation therapy done at the CCCL, at no cost to the family.
The program also promotes a collaborative effort among all oncologists. In turn, the oncologists work cohesively together to apply the appropriate treatment protocol. Combined with adequate follow up, this model ensures optimal outcomes. Such a collaborative effort has never before been implemented so successfully in Lebanon.
Since its start in August 2012, and until December 2012, 8 children have been enrolled onto this program.
The CCCL also launched the Retinoblastoma Program in August 2012 and in collaboration with St Jude Children’s Research Hospital in Memphis, TN, USA.
Retinoblastoma is an eye tumor most common among infants (up to 2 years old) and kids up to 10 years old.
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 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 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 plan. Through collaboration with their doctors, these children now can 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, and until December 2012, 8 children have benefited from this program.
A Pediatric Cancer Research Program and a Data Management Unit were also established during 2012.
The data management unit is formally evaluating the treatment and outcome of all children with cancer. It assures quality improvement by periodic assessment of quality and outcome measures in pediatric cancer care.
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.
Below are a number of important studies that were published in 2012:
1. A large study led by Dr. Samar Muwakkit and Dr. Miguel Abboud, showed that children with Acute Lymphoblastic Leukemia (ALL) who are treated at the CCCL with a treatment protocol developed by SJCRH, have excellent outcomes similar to those in the USA are Europe, with overall cure rates approaching 80% (see Pub#1 below).
2. A study led by Dr. Hajj-Fuleihan at AUBMC and Dr. Miguel Abboud showed that Lebanese children with ALL have some loss of bone mass during treatment, and identified some factors that may be associated with this chemotherapy side effect (see Pub#2 below).
3. Future work will now aim to better characterize these features, and to improve overall bone health in Lebanese children, in order to minimize such side effects whenever possible.
4. One study led by Dr. Raya Saab showed that, for children with a type of tumor called Ewing Sarcoma, a two-drug treatment that has been used in USA and in Europe can indeed help some children whose tumor came back after standard treatment (see Pub#3 below).
5. Another study led by Dr. Raya Saab showed that, children with a muscle tumor called Rhabdomyosarcoma have as good survival as those in the USA and in Europe, and are treated with the same drugs/protocols (see Pub#4 below). Interestingly, this study showed that our children can have more tumors returning after the same radiation treatment, as given in the USA, suggesting that the biology of our tumors may be different. Studies are now being done to better understand the biology of children in our region who develop this tumor, to better predict who will benefit from radiation treatment.
6. A biologic study performed by Dr. Raya Saab’s laboratory (Pub#5) showed that, for a type of brain tumors called pineoblastoma, new treatments may be useful if they target a specific protein called CDK2. This work is very early, and more work is being done in Dr. Saab’s laboratory to confirm this finding and better understand how such a drug may work.
7. Another biologic study done in Dr. Saab’s laboratory (Pub#6) investigated the usefulness of the drug Retinoic Acid in the muscle tumor Rhabdomyosarcoma.
Although thought to be promising in previous limited laboratory studies published in the USA and Europe, Dr. Saab’s laboratory found that this drug indeed seemed useful to slow down tumor cell division, but alone is not strong enough to stop tumor growth in living animals.
Work is now being focused to find stronger drugs and retinoic derivatives that may better stop Rhabdomyosarcoma tumor growth
- Pub#1: Muwakkit S, Al-Aridi C, Samra A, Saab R, Mahfouz RA, Farra C, Jeha S, Abboud MR. Implementation of an Intensive Risk Stratified Treatment Protocol for Children and Adolescents with Acute Lymphoblastic Leukemia in Lebanon. Am J Hematol. 2012.
- Pub#2: Hajj Fuleihan G, Muwakkit S, Arabi A, Daouk LE, Ghalayini T, Chaiban J, Abboud M. Predictors of bone loss in childhood hematologic malignancies: a prospective study. Osteoporos. Int. 2012.
- Pub#3: Farhat R, Raad R, Khoury NJ, Feghaly J, Eid T, Muwakkit S, Abboud M, El-Solh H, Saab R. Cyclophosphamide and Topotecan as first-line salvage therapy in patients with relapsed Ewing sarcoma at a single institution. J Pediatr Hematol Oncol. 2012
- Pub#4: Salman M, Tamim H, Medlej F, El-Ariss T, Saad F, Boulos F, Karam D, Eid T, Geara F, Muwakkit S, Khoury N, Abboud M, Saab R. Rhabdomyosarcoma treatment and outcome at a multidisciplinary pediatric cancer center in Lebanon. Pediatr Hematol Oncol. 2012.
- Pub#5: Zalzali H, Harajly M, Abdul-Latif L, El-Chaar N, Dbaibo G, Skapek SX, Saab R. Temporally distinct roles for tumor suppressor pathways in cell cycle arrest and cellular senescence in Cyclin D1-driven tumor. Mol Cancer. 2012.
- Pub#6: Al-Tahan A, Sarkis O, Harajly M, Kebbe Baghdadi O, Zibara K, Boulos F, Dighe D, Kregel S, Bazarbachi A, El-Sabban M, Skapek SX, Saab R. Retinoic acid fails to coordinate cell cycle arrest with myogenic differentiation in rhabdomyosarcoma: implications for therapeutic use. Pediatr Blood Cancer. 2012.
Each year, we celebrate the graduation of new Pediatric Oncology specialists. Specialists complete a Hematology-Oncology Fellowship program at the CCCL/AUB Medical Center. This year, we celebrated the graduation of the following doctors:
a. Dr. Shadi Hamzeh:
Dr. Hamzeh plans to carry on the mission of pediatric oncology in the underserved region of Akkar. We wish him the best and we hope to continue working with him to provide the best care to all children with cancer in the region.
b. Dr. Rawad Farhat:
Dr. Farhat moved to the USA, after her graduation, for further training and plans to return to Lebanon after fulfilling her career goals.