Comprehensive Cancer Center Vienna

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1 Comprehensive Cancer Center Vienna Outline - Overview Russian Cancer Research Center Blokhin Moscow,

2 Mission/Visions The CCC Vienna has started in 2010 in order to bring together a great variety of clinical department and research institutions in order to coordinate projects and actions in/for Basic Science (Research Clusters) Translational Research (CCC Units) Clinical Trials (Clinical Trial Unit in progress) Patient Care (Tumour Boards, CCC Units) Student Education (Vienna Summer School on Oncology) Medical Education (SOPs and CCC-Grand Rounds) Research Training Career Advancement (CCC-Young Scientists and PhD Programs)

3 CCC Components I 28 Clinical Departments and Divisions of the Medical University (MUV) & the General Hospital Vienna (AKH) Clinical Pharmacology Dermatology Ear, Nose and Throat Diseases Emergency Medicine Gynaecology Hospital Hygiene Internal Medicine I (Dept. Medical Oncology), II, III (Dept. Gastroenteorlogy / Hepatology) Laboratory Diagnostics Neurology I, II Neurosurgery Nuclear Medicine Ophthalmology Oral, Maxillary and Facial Surgery Orthopaedics Pathophysiology Pathology Paediatrics and Adolescent Medicine Physical Medicine and Rehabilitation Psychiatry and Psychotherapy Radiology Radiotherapy Special Anaesthesia and Pain Management Specific Prophylaxis and Tropical Medicine Surgery Urology

4 CCC Vienna 22 tumor boards listed, 18 of these are active TB pancreatic tumors TB esophagus-, stomach cancer and GIST TB Colon / Rectum Malignancies TB Liver Malignancies Interdisciplinary conference surgery / medical oncology breast cancer Interdisciplinary breast cancer-tb of special gynecology TB gynecologic tumors TB pediatric malignancies (St.Anna) TB Brain- and spinal cord tumors in children and adulescents Neuro-oncologic tumor board TB ENT tumors TB urogenital tumors TB thoracic tumors TB skin tumors TB bone and soft tissue TB Leukemia and Lymphoma Blastenshow Lymphoma consultations TB endokrine tumors ophthalmologic-onkologic tumor board oncologic rehabilitation Transplantation

5 Tasks of the Interdisciplinary Tumor Board to discuss and plan the optimal multimodal treatment for cancer patients together develop / improve interdisciplinary SOPs Scientific evaluation according to international reference standards Multidisciplinary strategies for prevention and early detection

6 Operating Guidelines Tumorboard mandatory members of the TB tasks of the TB-organizer tasks of Case-Managers documentation and organisation of the TB tumor data bank tumor board assistent data for outcome-analysis

7 Members of the Tumorboard Diagnostic disciplines: radiology endoscopy nuclear medicine pathology Surgical or interventional disciplines surgery (and other surgical disciplines) interventional endoscopy Interventional radiology Conservative therapeutic disciplines organ-related specialty disciplines (e. g. gastroenterology, hepatology, urology, gynecology) medical oncology radiation oncology and: Tumorboard-assistents

8 Intranet-based Communication and Documentation Plattform Plattform for real-time case discussions Online-availability of all relevant diagnostic information Possibility for planning of further diagnostic and therapeutic work-up? Online-documentation of results of the consultations Connection to a centralized tumor registry (tumor data bank)? Logistics for automatic Follow-up of oncologic patients?

9 Education/QM The CCC Vienna supports the development of Standard Operating Procedures (SOPs) for important interdisciplinary operational sequences in oncologic care and research. They are freely available at the CCC-homepage. The first SOPs cover the topics of: Antineoplastic Therapy (valid for the entire hospital) Good Scientific Practice within the CCC Establishment of CCC Units

10 Interdisciplinary SOPs Establishment / continous improvement of evidence-based guidelines for diagnosis, treatment, and follow-up of malignant diseases SOP on how to establish an interdisciplinary SOP screen for already existing SOPs coordinate them evidence-based SOP vs. clinically-oriented SOP

11 Interdisciplinary SOPs 2011: 5 organ specific SOPs pancreatic cancer lymphoma colorectal cancer hepatocellular carcinoma CNS tumors

12 Screening for HCC Could be part of an HCC SOP Is not part of our SOP in Vienna Task for Hepatologists managing patients with cirrhosis If yes: Ultrasound every 6 (to 12) months AFP not recommended, can be done

13 HCC Diagnostic Algorithm HCC EASL-EORTC Clinical Practice Guidelines HCC, JHEP 2012; 56: 908

14 HCC Assessing Treatment-Response: RECIST vs. mrecist Lencioni et al., Semin. Liver Dis. 2010; 30: 52 CR= disapperance of target lesions CR= disapperance of any tumoral enhancement in all target lesions PR= 30% decrease Ø of target lesions from baseline PR= 30% decrease Ø of viable (arterial enhencement) target lesions from baseline SD= no PR & no PD PD= 20% increase Ø of target lesions (from smallest Ø since start of treatment) SD= no PR & no PD PD= 20% increase Ø of viable (enhencing) target lesions (from smallest Ø of viable lesions since start of treatment)

15 HCC BCLC-Classification + Algorithm Bruix & Llovet. Lancet 2009; 373: 614

16 What to do if standard treatment are not available? Liver Transplantation Resection with higher risk Local ablation (RFA) TACE? Radiofrequency ablation ethanol injection stereotactic radiotherapy? TACE TACE Stereotactic radiotherapy 90 Y-radioembolisation? sorafenib Sorafenib TACE? clinical studies? BSC? HCC

17 Follow-up of HCC patients No official recommendations in Guidelines Curative Treatment Options Year 1: Imaging (CEUS/CT/MR) q3m Year 2 and on: Imaging q6m Palliative Treatment Options Imaging (CEUS/CT/MR) q3m Optional (in AFP+ tumors): AFP HCC

18 Important issues For running the tumor board The case manager is introducing the patient and will remain responsible for the management according to the TB recommendations The patient is usually referred back to the case manager after an intervention for follow-up The opinion of the case manager weighs heavily in the tumor board decision Respect your collegues expertise and knowledge For the SOP s especially define what NOT to do in a given situation HCC

19

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