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Improving clinical decision making in childhood cancer

Neuroblastoma is one of the most common cancers which affects young children under the age of three, but for paediatric oncologists it is still a major challenge in terms of diagnosis and treatment. In many cases the development of these tumours of the nervous system varies greatly, despite early biopsy and similar pathological profiles, and this makes deciding on the best treatment much more difficult.

The Children’s Cancer Research Group at the Christchurch School of Medicine and Health Sciences, led by paediatric oncologist Dr Michael Sullivan and scientist Dr Glen Reid is now investigating ways of improving clinical diagnosis and treatment of these cancers, through greater understanding of their molecular characteristics.

“Our primary focus is to improve understanding of the different types of neuroblastoma or cancer of the developing nervous system, as this directly relates to the kind of treatment that can be applied to these tumours,” explains research scientist Dr Reid.” What we have at the moment is a series of ‘grey gradations’ in our understanding of neuroblastoma tumours which make it quite difficult to determine how they will develop; whether a particular tumour will be regress or spread.”

The Group is classifying tumours through the use of microarray which allows the analysis of tens of thousands of genes at the same time, and relating this information to clinical data on the age of the child, stage and prognosis of the disease, response to therapy and whether the tumour has metastasised.

“ Through microarray analysis of genetic samples we are able to develop clusters of types of tumours which have similar characteristics and may indicate a good or bad outcome for the patient,” says Dr Reid.

“They may all look the same in terms of clinical characteristics, but gene expression under microarray will provide much more accurate information as to whether the tumour will regress or progress into a more aggressive and more dangerous phase. In essence we are looking for molecular signatures which will allow us to classify tumours more precisely.”

The Children’s Cancer Research Group is also examining hepatoblastoma, a cancer of the liver in children. Little is known about this rare disease or its molecular characteristics and controlling features, as these originate in the developing gut of the fetus.

Surgical removal is usually the first line of treatment with all these cancers if they haven’t spread and the tumour is still at an early stage. If the tumour is very large often chemotherapy is used to shrink the tumour mass before surgery says Dr Sullivan.

The other important tool the Children’s Cancer Research Group will utilise is the Evolving Fuzzy Neurol Network (EFuNN), which has been developed by the Knowledge Engineering Laboratory (KEDRI) at the Auckland University of Technology.

When the Group has enough data on different tumours, it will feed this information into EFuNN along with clinical and chromosomal changes from patients. The aim is to assess whether this sophisticated computer tool can assist with the prediction of clinical outcome by combining all factors characterising a tumour, and thus enhance treatment.

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