New WHO Classification of Brain Tumours: major theme at the 8th Annual Meeting of the Indian Society of Neuro Oncology (ISNO) Meeting Dr Chilukuri Srinivas, Organising Secretary of ISNOCON 2016 and Dr Rakesh Jalali, President, ISNO India THE Indian Society of Neuro-oncology (ISNO) held its 8th annual meeting in Hyderabad from 1st -3rd April 2016. More than 400 delegates from various parts of India and eleven international speakers attended the meeting. India, being the land of diversity, has a few hospitals with world-class facilities at par with leading institutions around the globe. But at the same time there are many centres with only basic facilities. One of the major challenges our Indian society has faced thus far has been to bridge this gap and to create ways of communication and cooperation among various oncologists and institutes. The theme of this year’s event was the updated WHO classification of brain tumours, which incorporates specific molecular markers and will be adopted worldwide. The existing classification is based primarily on histopathology, which in turn is based on understanding how different a tumour cell is from a normal cell. The newer classification will lead to a better understanding of brain tumours based on biological changes rather than just the morphology. When specific alterations such as the IDH mutation or a TERT mutation happens in normal cells, they live, grow and divide without the usual controls normal cells have. The impact of the newer WHO classification is likely to be significant and will be incorporated in all clinical trial designs. Speakers in this dedicated session jointly conducted by ISNO and the Neuropathology Society of India highlighted the molecular pathology developments during the recent decade and summarised their major impact which 114
Brain Tumour
Above: Dr Rakesh Jalali (right) presents the Ab Guha Oration Plaque to Dr Patrick Wen (left) at the ISNO meeting.
has been incorporated in the updated WHO classification. A talk on minimum pathology reporting in the Indian context by Dr. Chitra Sarkar and Dr. Vani Santosh drew a fair amount of attention among the attendees. This half-day session ended with a panel discussion addressing specific concerns by the clinician and pathology community in India. ISNO will produce a document with clear guidelines about pathology reporting in accordance with the new WHO classification and incorporating minimum and desired testing. This document will be disseminated throughout the country and discussed at various fora in the next year or so. The yearly “Do Not Miss” session included four high impact research highlights from the recent past: the novel Tumour Treating Fields (TTF) trial in glioblastoma, TCGA (The Cancer Genome Atlas) and RTOG 9802 trial data in low grade gliomas as well as the recent
molecular insights into ependymomas. Other sessions included discussions on optimal management of benign brain tumours, the direction of current neurooncology research including immunology, immunotherapeutics, radiogenomics and brain metastasis. The session for negotiating palliative care in neurooncology in the context of cultural and linguistic diversity focussed on the gaps and social stigma in this field as well as the need for a greater commitment to the concept of palliative care in neuro-oncology. Interactive parts of the programme included “Hard Talk” sessions that involved probing the expert for a deeper understanding of newer philosophies, the role of the tumour board and debates on chemotherapy, VEGF inhibition and surgical mapping versus image guidance. Dr. Patrick Wen (Director of Neuro Oncology at Dana-Farber Cancer Insitute in the US) delivered the prestigious,