Center for Pediatric Neurooncology

Our motto: Only centralized care makes sense today

Center for Pediatric Neurooncology (CDNO) represents the nationally unique interdisciplinary project of the University Hospital in Motol and the 2nd Faculty of Medicine of Charles University. The cooperation of a number of clinics and institutes provides comprehensive diagnostic, therapeutic, nursing, rehabilitation and dispensary care for children and young patients with cancer of the central nervous system. Care does not end at the age of 18, but monitoring continues throughout life. The following workplaces in particular take part in the care:

CDNO is designed to provide world-class professional care. Ensuring a high level of care depends mainly on the staffing of experienced experts, modern diagnostic background, instrumentation and continuity of other specializations. The physical proximity of all workplaces within one building and the constant availability of erudite experts and the most modern examination and treatment methods cannot be neglected.

The volume of patients treated and monitored with CDNO is crucial, and absolutely essential, for gaining experience. The center is the largest workplace of its kind in the Czech Republic and one of the largest in Europe. The activities of the center are under constant supervision, we have been monitoring clearly defined and objective indicators of the center's performance and quality for a long time. 

An integral part of CDNO's work is participation in basic and clinical research. The research group within the CDNO "Prague Brain Tumor Research Group" brings together participating clinics, the Laboratory of Solid Tumor Biology (LBSN) and the Laboratory of Molecular Pathology (LAMPA). Today, we cannot imagine research without extensive national and especially international cooperation; The CDNO is part of, for example, the European Reference Network on Pediatric Cancer (hemato-oncology), the International Society for Pediatric Oncology (SIOP) and the Innovative Therapies for Childhood Cancer (ITCC). This allows the participation of CDNOs in otherwise unavailable recent clinical trials. We can thus offer our patients a completely unique treatment in the Czech Republic and access to the most modern or only experimental treatment procedures.

All CDNO staff understand that the diagnosis of a central nervous system tumor in a child is a crucial event that will turn the life of the whole family upside down. Our proposed therapeutic procedure aims to minimize the unpleasant aspects of the treatment process and enable the whole family to return to normal life as soon as possible. In addition to the treatment itself, we also focus on the social aspects of the disease. Above all, we focus on continuing the patient's education through the school at the hospital, palliative and supportive care and, last but not least, on psychological counseling for the whole family. For families with patients with a particularly serious diagnosis, we have been offering a connection with the Motol Child Support Team from the beginning, which consists of experts who can significantly alleviate this situation for the family. Throughout the treatment process, we regularly and in detail inform the patient and his family about the nature of the disease, planned examinations, their results and subsequent treatment and its risks. We consider communication with the family and ongoing information to be a key part of our work. 

Our goals

  • Complete healing of the patient where the biological nature of the tumor allows it
  • Comprehensive interdisciplinary care in one place in real time
    Use of the latest methods to improve overall survival in incurable tumors
  • Allowing to lead a normal life if possible with an incurable cancer
  • Minimization of complications and side effects of treatment
  • Introduction of new treatments in international academic studies
  • Genetic counseling for families with children with cancer (siblings, other planned pregnancies)

CNS tumors are relatively rare in childhood (incidence about 4 / 100,000 children), yet they are the most common solid childhood cancer. Tumors can be benign or malignant. However, both types can endanger a child with a neurological deficit (eg limb mobility) or directly in life. However, compared to adults with the same diagnosis, children have a significantly better prognosis - most children with a CNS tumor live to adulthood. In the Czech Republic, the incidence of CNS tumors in children has been increasing slightly for a long time (approximately 1,4% per year), but fortunately their mortality has been declining for a long time. Every year, approximately 80-90 CNS tumors are newly diagnosed in the Czech Republic, more than half of which are either treated directly at our Center or are later referred to it for further care or long-term follow-up.

  • Management of the Center for Pediatric Neurooncology

    • Supervisor: MUDr. Michal Zapotocky, Ph.D. (Department of Pediatric Hematology and Oncology)

    • Deputy Head: Doc. MUDr. Vladimir Benes, Ph.D. (Department of Neurosurgery for Children and Adults)

  • Doctors from individual clinics and institutes:

    • Department of Pediatric Hematology and Oncology

      • MUDr. Michal Zapotocky, Ph.D.

      • MD David Sumerauer, Ph.D.

      • MUDr. Ales Vicha, Ph.D.

      • MUDr. Jarmila Kruseova, Ph.D.

      • MUDr. Katerina Vanova, Ph.D.

      • MD Lucie Slámová, Ph.D.

      • MUDr. Adéla Mišov

    • Department of Neurosurgery for Children and Adults

      • Doc. MUDr. Vladimir Benes, Ph.D.

      • Doc. MD Michal Tichý, CSc

      • Doc. MD Petr Libý, Ph.D.

      • MD Jakub Táborský

      • MUDr. Jana Blazkova Jr.

    • Department of Pediatric Neurology

      • Prof. MD Pavel Kršek, Ph.D.

      • MD Martin Kudr, Ph.D.

      • MD Ivana Perníková

      • MD Alena Jahodová, Ph.D.

      • MD Bořivoj Petrák, CSc.

      • MUDr. Matthias Ebel

    • Department of Imaging Methods

      • MD Martin Kynčl, Ph.D.

      • MD Radek Pádr

    • Department of Pathology and Molecular Medicine

      • Prof. MD Josef Zámečník, Ph.D.

      • RNDr. Lenka Krsková, Ph.D.

      • MUDr. Miroslav Koblízek

    • Department of Biology and Medical Genetics

      • MD Markéta Havlovicová

      • MD Markéta Vlčková, Ph.D.

    • Pediatric clinic

      • Prof. MUDr. Zdenek Sumnik, Ph.D.

      • MUDr. Stanislava Kolouskova, CSc.

    • Department of Anaesthesiology, Resuscitation and Intensive Care

      • MD Jana Pavlíčková

      • MUDr. Jana Blazkova st.

      • MD Petr Pavlíček

    • Department of Rehabilitation and Sports Medicine

      • MD Olga Dyrhonová

      • MD Pavla Slivková

    • Motol Child Support and Palliative Care Team at Motol University Hospital
      • MUDr. Lucie Hrdličková

      • MUDr. Katalin Štěrbová

The facilities of the University Hospital in Motol and the 2nd Faculty of Medicine allow CDNO to benefit from the most modern instrumentation and laboratory equipment. For diagnostics, we mainly use top 3-body magnetic resonance imaging with the possibility of functional imaging and imaging of nerve pathways. Computed tomography, ultrasound, classical sciascopy (X-ray) and digital subtraction angiography are a matter of course. The laboratory relies on blood analysis, biochemical examination, examination of hormones and specific oncomarkers. Other specialized examination methods include, for example, EEG (electrical activity of the brain) with the possibility of video recording, evoked potentials, electromyography (conduction of excitations from the brain to the muscles), invasive measurement of intracranial pressure and more. 

To remove the tumor itself, we use a modern operating microscope with the possibility of fluorescent imaging of pathological tissue, exoscope (3D imaging), endoscope or ultrasonic tumor aspirator (aspirator). We have an endoscopic ultrasound tumor aspirator, with which we are able to remove smaller tumors in the area of ​​the ventricular system at least invasively. 

We monitor brain function and nerve integrity during surgery electrophysiologically. Orientation during performance in complex anatomical localizations, or minimizing access, is enabled by perioperative navigation showing in real time a place correlating with magnetic resonance. Anesthesiology has a ventilator for pediatric patients. 

Postoperative examination is not limited to classical histological analysis, but we use modern immunohistochemical methods that allow closer identification of the tumor and especially its molecular genetic equipment using DNA and RNA analysis. In this way, we discover known and new genetic subtypes of tumors, which is a necessary condition for starting modern or experimental treatment.

Few medical industries have experienced such a boom in pediatric neurooncology in the last decade. The clinics and institutes that make up the CDNO are among the European and world-renowned workplaces in their field, they regularly publish their treatment results and experimental work in renowned journals and scientific conferences, and participate in grant projects and international studies:

  • INFORM INdividualized Therapy FOR Relapsed Malignancies in Childhood
  • LOGGIC Core BioClinical data Bank (LOGGIC - Low Grade Glioma In Children) - in cooperation with Hopp Children's Cancer Center Heidelberg, University Heidelberg, Germany (LOGGIC Core version 1.4)
  • International Clinical Program for the Diagnosis and Treatment of Children, Adolescents and Young Adults with Ependymoma - in collaboration with the Center Léon Bérard, Lyon, France (ET-13-002)
  • International prospective study in children with medulloblastoma (MB) older than 3 years and WNT biological profile (PNET 5 MB - LR and PNET 5 MB - WNT-HR), standard risk biological profile (SIOP PNET 5 MB - SR), or TP53 mutation, and the registry of the occurrence of MB in the context of genetic predisposition - in cooperation with Univ. Copper. Center Hamburg - Eppendorf, Germany (SIOP PNET 5 MB Version 12-2017, Jun 29)
  • Phase 1/2 clinical trial of oral TRK inhibitor larotrectinib in pediatric patients with advanced solid tumors or primary central nervous system tumors - in collaboration with Bayer Consumer Care AG (BAY 2757556/20290)
  • Selumetinib - a specific treatment program from Astra-Zeneca for patients with NF-1 and pleximore neurofibroma

Within the Center for Pediatric Neurooncology, we bring patients from all over the Czech Republic and abroad to the Motol University Hospital. A sufficient number of cases guarantees the experience of neurosurgeons, enables the establishment of specialized seminars and participation in the latest medical studies. On average, our center operates 60-70 patients a year, and even more, thanks to centralization, is treated through the Department of Pediatric Hemato-Oncology. With this number of patients, the well-known equation applies even more than ever:

High patient volume = more experience = less complications = better results

Of course, there is a database (in compliance with all GPDR guidelines) of all treated and monitored patients and ongoing quality control of care. That is why we publish some generally accepted indicators of quality of care on these pages:

  • Number of patients with newly diagnosed CNS cancer treated in CDNO

  • Number of neurosurgical procedures for cancer
  • Number of operations for disease recurrence

Department of Pediatric Hematology and Oncology, 2nd Medical Faculty, Charles University and Motol University Hospital

Secretariat:
Iva Růžičková
phone: 224 436 401
e-mail: iva.ruzickova@fnmotol.cz
location: Children's part of the hospital, 5th floor

Department of Neurosurgery, 2nd Medical Faculty, Charles University and University Hospital Motol

Secretariat:
Andrea Prochazkova, DiS.
tel .: 22443 2501
e-mail: andrea.prochazkova@fnmotol.cz
location: Children's part of the hospital, lower ground floor (SP)

Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital

Secretariat:
Alena Skrabankova, DiS.
phone: 224 433 301
e-mail: alena.skrabankova@fnmotol.cz
location: Children's part of the hospital, 3th floor


MUDr. Michal Zapotocky, Ph.D.
e-mail: michal.zapotocky@fnmotol.cz

doc. MUDr. Vladimir Benes, Ph.D.
e-mail: vladimir.benes@fnmotol.cz

  • Interview of Martin Kovář on Radio Zet
    "Pediatric neurosurgery in Motol is at the world's top, says neurosurgeon Vladimír Beneš Jr.

https://www.radiozet.cz/podcast/detska-neurochirurgie-v-motole-je-na-svetove-spicce-tvrdi-neurochirurg-vladimir-benes-ml

STATUTE
CENTER FOR CHILDREN'S NEUROONCOLOGY
University Hospital in Motol

Preamble:

Based on the Charter of the University Hospital in Motol and in accordance with the Program for Improving the Quality and Safety of Health Services, the University Hospital in Motol is established Center for Pediatric Neurooncology (CDNO).

The mission of CDNO is to care for patients with cancer of the nervous system up to the age of 18 (hereinafter children) and their subsequent long-term follow-up. 

Article I
Introductory provisions

1. CDNO is a part of the University Hospital in Motol.

2. The full name is the Center for Pediatric Neurooncology.

3. The seat of the CDNO is the University Hospital in Motol, V Úvalu 84, 150 06, Prague 5.

4. The foreign language equivalents of the name Center for Pediatric Neurooncology are:

English: Center for Pediatric Neuro-oncology

French: Center de Neuro-oncologie Pédiatrique

German: Zentrum für pädiatrische Neuro-Onkologie

Russian: ентр детской нейроонкологии

Article II.
Scope of business

1. CDNO is a specialized workplace that provides comprehensive diagnostic, therapeutic, nursing, rehabilitation, psychological, psychosocial and palliative care for pediatric patients with cancer of the central nervous system and their subsequent long-term dispensarization, especially in the following indications:

  1. Benign and malignant tumors of the nervous system in pediatric patients and their complications.
  2. Active search and solution of long-term consequences of cancer or oncological treatment within a long-term dispensary.
  3. Search for genetic hereditary predispositions to central nervous system tumors with a follow-up program for these patients.

2. Patient care in CDNO will be at the highest current level and in compliance with all recommended standard diagnostic and therapeutic procedures.

3. CDNO forms the educational, scientific and research basis for the issue of cancer of the nervous system in pediatric patients and their subsequent lifelong dispensarization.

4. CDNO participates in undergraduate and postgraduate teaching.

5. The CDNO concept is subject to approval by the Scientific Board of the University Hospital in Motol.

Article III.
Organizational structure and management

1. CDNO is the basic organizational unit of the University Hospital in Motol and has the status of an interdisciplinary workplace - organizational units of two or more organizational units permanently performing common tasks.

2. CDNO is not a separate cost center.

3. The CDNO is obliged to properly manage the entrusted property of the University Hospital in Motol and to use it effectively as well as to take care of its reproduction, if the nature of the property allows it.

4. The head of the Center for Pediatric Neurooncology is appointed by the director of the University Hospital in Motol on the proposal of the deputy for medical and preventive care.

5. The head of the CDNO is responsible to the director of the University Hospital in Motol for the professional level of care, management and administration of the Center for Pediatric Neurooncology and comprehensively coordinates its activities.

6. In the absence of the CDNO, the head of the CDNO is fully represented by his deputy, who is appointed head of the Center for Pediatric Neurooncology.

7. The CDNO has developed its own program (including the concept), which is in accordance with the operating rules and internal legislation of the University Hospital in Motol. The program of the center forms an annex to the statute of the center.

Article IV.
Final Provisions

1. Amendments to this statute are issued by the director of the University Hospital in Motol.  

2. This statute is made in two identical copies with the validity of the original, one of which will be received by the CDNO and one by the University Hospital in Motol.

3. The statute becomes valid and effective on the day it is signed by the director of the University Hospital in Motol.

Center program (concept)

The Center for Pediatric Neurooncology is designed to provide world-class professional care for pediatric patients with nervous system cancer. This requires the staffing and technical and material equipment defined below, enabling modern diagnostics and treatment, as well as links to other specializations and active clinical and translational research. The key to ensuring quality care is the experience of the staff, which is guaranteed only with a minimum annual volume of patients with the issue. In the field of pediatric neurooncology according to European standards in the care of children with cancer, it is defined as at least 30 newly diagnosed patients per year. Only such a center should be able to perform diagnostics, surgery, treatment and long-term dispensary of pediatric neurooncology patients in the Czech Republic.

1.  Objectives of the Center for Pediatric Neurooncology

a. Comprehensive diagnostic and therapeutic care for pediatric patients with cancer of the nervous system.

b. Long-term follow-up of patients with cancer of the nervous system diagnosed or treated during childhood.

c. Active search for long-term consequences of cancer or the consequences of its treatment.

d. Routine and innovative diagnosis of genetic inherited syndromes with a predisposition to cancer and subsequent monitoring of these patients.

e. Centralization will achieve the maximum level of care for pediatric patients with oncological diseases of the nervous system, especially with rare units.

f. Centralization will lead to the effective use of available resources and the concentration of experience in the diagnosis and treatment of oncological diseases of the nervous system in pediatric patients, especially in rare units.

g. Support for international cooperation will bring the possibility of enrolling patients in studies with new diagnostic and therapeutic procedures.

2.  Internal organization (structure) and management of the activities of the Center for Pediatric Neurooncology

a. CDNO is an interdisciplinary department covering the fields of diagnosis and treatment of cancer of the central nervous system diagnosed in childhood, in particular the following departments:

1. Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital

2. Department of Pediatric Neurology, 2nd Faculty of Medicine, Charles University and Motol University Hospital

3. Department of Neurosurgery for Children and Adults, 2nd Faculty of Medicine, Charles University and Motol University Hospital

4. Department of Pediatrics, 2nd Medical Faculty, Charles University and University Hospital Motol

5. Department of Imaging Methods, 2nd Faculty of Medicine, Charles University and Motol University Hospital

6. Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital

7. Department of Biology and Medical Genetics, 2nd Faculty of Medicine, Charles University and Motol University Hospital

8. Department of Anaesthesiology, Resuscitation and Intensive Care Medicine, 2nd Medical Faculty, Charles University and University Hospital Motol

9. Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital

  1. Department of Radiotherapy, Department of Oncology, 2nd Medical Faculty, Charles University and University Hospital Motol
  2. Department of Clinical Psychology, Motol University Hospital
  3. Other workplaces are involved in the diagnostic-therapeutic process on the basis of current needs.

b. The individual clinics and institutes work closely together during the diagnostic, therapeutic and dispensary phases of the treatment process.

c. Individual clinics and institutes strictly adhere to the latest diagnostic and treatment protocols in accordance with the principles of "lege artis" and "evidence-based medicine".

d. Individual clinics and institutes are fully responsible for adequate education of the patient and his / her legal representative in connection with the diagnostic-therapeutic process and for signing informed consent.

e. Patient care is coordinated through regular joint seminars and continuous consular availability.

f. Long-term follow-up is ensured by clinical monitoring by an oncologist and neurologist and regular imaging examinations. According to the development of late consequences, specialists in the field of endocrinology, neurology, otorhinolaryngology, obesitology and dentistry of the 2nd Medical Faculty of Charles University and the Motol University Hospital also take part in further care. Adult patients at risk of post-treatment infertility are monitored at the Institute of Biology and Medical Genetics of the 2nd Medical Faculty of Charles University and the Motol University Hospital.

g. The workplaces mentioned in point 2a are mainly involved in the dispensary.

h. Long-term patient care is provided within the Motol University Hospital in cooperation with the Department of Neurosurgery for Children and Adults of the 2nd Medical Faculty of Charles University and the Motol University Hospital, the Department of Neurology of the 2nd Medical Faculty of Charles University and the Motol University Hospital and the Department of Oncology of the 2nd Medical Faculty of Charles University and the Motol University Hospital.

3. The catchment area of ​​the Center for Pediatric Neurooncology

a. CDNO does not have a defined catchment area, it accepts and dispensaries monitors patients from all over the Czech Republic.

b. In case of interest, CDNO also accepts and dispensaries monitors foreign patients (whether with care paid for by their health insurance or self-paying).

4. Staffing of the Center for Pediatric Neurooncology

a. Head of CDNO - a doctor with specialized competence in the field of Pediatric Oncology and Hematology with at least 5 years of experience in the indication and planning of treatment of central nervous system cancers, in the scope of full-time (1,0).

b. Deputy Head of CDNO - a doctor with specialized qualifications in the field of Pediatric Oncology and Hematology or Neurosurgery or Pediatric Neurology with at least 5 years of experience in indicating and planning treatment of central nervous system cancers, full-time (1,0).

c. Physicians from the establishments listed in point 2a with appropriate specialized competence in the field, of which at least two have at least 5 years of experience focused on pediatric patients and a minimum working time of 0,5. The total number of working hours of physicians from the workplaces named in point 2a involved in the activities of the CDNO (with and without specialization in the field) will be at least 5,0.

d. Other staff of the center:

1. Physician with specialized competence in the field of Child Psychiatry; at least 0,1 working hours.

2. Physician with specialized competence in the field of pediatric endocrinology and diabetology; at least 0,2 working hours.

3. Clinical anthropologist; at least 0,5 working hours.

4. Physiotherapist; at least 1,0 working hours.

5. Occupational Therapist; at least 0,5 working hours.

6. Clinical speech therapist; at least 0,2 working hours.

7. Health and social worker; at least 0,2 working hours.

8. Nutritional therapist; at least 0,2 working hours.

e. Patients and midwives are also involved in the treatment of patients. Secondary medical staff is dedicated to the care of a pediatric patient with adequate specialized education (University degree in medical care, completion of specialized education in the field of Nurse).

f. A dedicated administrative staff member participates in the coordination of the dispensary, who ensures the necessary imaging and clinical monitoring at regular intervals; at least 0,5 working hours.

5. Material and technical equipment of the Center for Pediatric Neurooncology

a. Spatial security

1. The CDNO shall use the bed capacities of the workplaces mentioned in point 2a.

2. The patient is directed to a workplace that requires his current state of health.

3. The inpatient workplaces listed in point 2a shall always have at least 3 beds in the standard ward and 1 intensive care bed for the needs of the CDNO.

4. A dedicated outpatient clinic is available within the CDNO workplaces, where outpatient examinations and dispensary inspections take place.

b. Instrumentation and technical equipment

1. Computed tomography (CT), magnetic resonance imaging (MRI) and other imaging methods are available for CDNO diagnostic needs.

2. Examination by positron emission tomography is routinely available in cooperation with the PET Center of the Homolka Hospital.

3. A hospital laboratory complement is available for CDNO.

4. Blood derivatives are available continuously for CDNO.

5. CDNO freely has the existing instrumentation and space equipment of individual workplaces according to the current situation.

6. Perioperative histological examination is available for CDNO.

7. The basic processing of tumor tissue samples takes place directly in the operating room with the possibility of deep freezing in the laboratory within 20 minutes of collection.

8. Frozen samples and samples in paraffin blocks are in the Laboratory of Molecular Pathology - LaMPa (Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital) and Laboratory of Solid Tumors - LBSN (Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital) processed and frozen as standard according to the procedures established at the Institute of Pathology and Molecular Medicine and the Department of Pediatric Hematology and Oncology, which correspond to good laboratory practice. Samples that are used within the CDNO are not stored separately and exclusively, but are classified, processed and stored as established for other samples received by these laboratories. Sample names are anonymized in LBSN by an alphanumeric code that does not contain any alphanumeric series of first name, last name, date of birth, and birth number, so it is not possible to trace a patient based on this information. The sample code thus does not contain GDPR sensitive data. At the Institute of Pathology and Molecular Medicine, isolated nucleic acid samples are identified by an isolation number and surname, but the samples are treated according to GDPR rules. GDPR sensitive data is stored in an isolated database or hospital system and is provided with a password. These databases are accessible in the laboratories on FNM computers in locked rooms, to which only FNM employees have access. The samples themselves are then placed in freezers at -20 oC and -80 oC, or in liquid nitrogen. These freezers and liquid nitrogen containers are located in closed rooms, to which only FNM employees have access. The storage of paraffin-embedded samples is governed by a standard procedure that is part of the accreditation of the Department of Pathology and Molecular Medicine.

9. Immunohistochemical methods follow the basic histopathological examination.

  1. Simultaneously or subsequently with the histological examination, a molecular biological examination takes place, which is ensured by mutual cooperation of the Laboratory of Molecular Pathology (Department of Pathology and Molecular Medicine, 2nd Medical Faculty, Charles University and Motol University Hospital) and the Laboratory of Solid Tumors (Department of Pediatric Hematology and Oncology ). These laboratories are fully equipped for molecular biological examinations of CNS tumors. The laboratories have a bioinformatics that provides bioinformatics analyzes for next-generation sequencing. The molecular biological methods we use to diagnose CNS tumors include:

a. PCR and RT-PCR, or ddPCR

b. FISH

c. Direct sequencing method

d. MLPA

e. Next generation sequencing (NGS) at the DNA and RNA level

f. SNParray and methylation SNParray

g. Fragmentation analysis

  1. In indicated cases, examination of germinal pathogenic variants (hereditary tumor predispositions) is available.

a. Patients for examination of hereditary tumor predispositions are recommended by an oncologist based on the type of tumor, family history and other circumstances (therapeutic purposes).

b. Molecular examination is preceded by consultation with a clinical geneticist.

c. Laboratory testing options include, but are not limited to:

1. Targeted examination by sequencing methods according to Sanger and MLPA.

2. If necessary, in STATIM mode, results in genes TP53 a SMARCB1 we guarantee the examination within 10 working days.

3. Massively parallel sequencing method - in case of suspected heterogeneous etiology, cooperating service laboratories provide.

  1. In case of diagnostic ambiguities, CDNO has the opportunity to consult our results abroad; or, if the examination is not introduced in our country, sending the material for further examinations to a foreign workplace.

6. Financial support of the Center for Pediatric Neurooncology

a. Patient care is reported to health insurance companies.

b. CDNO actively participates in grant projects of the European Union, the Ministry of Health, the Agency for Health Research, Charles University and other institutions.

7. Control activities of the Center for Pediatric Neurooncology

a. The CDNO regularly monitors the following indicators of the quality of health care provided and regularly as of 1.6. publishes the results for the previous year.

b. CDNO quality and performance indicators:

1. Number of pediatric patients with newly diagnosed CNS cancer in the past year.

2. Number of performed neurosurgical procedures for cancer.

3. Mortality within 30 days of the operation.

4. Repeated admission within 30 days of surgery.

5. Number of patients operated for recurrence of the underlying disease in the past year.

c. Data collection:

1. The CDNO primarily collects data in a prospective manner.

2. For the needs of scientific studies, a retrospective analysis of a certain issue is also permissible.

3. The data shall be stored in dedicated databases which shall be managed in accordance with Regulation (EU) 2016/679 of the European Parliament and of the Council.

8. Scientific and research activities of the Center for Pediatric Neurooncology

a. CDNO is actively involved in basic and clinical research.

b. The CDNO prospectively monitors treated patients through a dedicated database.

c. CDNO actively participates in mono- and multicentre scientific studies at the national and international levels.

d. CDNO actively seeks to obtain grant funds from the European Union, the Ministry of Health, the Agency for Health Research, Charles University, the 2nd Faculty of Medicine, Charles University and other institutions.

e. The results of CDNO's scientific activities are presented in the form of lectures, expert articles and other scientific results.

9. Cooperation of the Center for Pediatric Neurooncology with other departments of the Faculty of Medicine and the 1st and 2nd Medical Faculty of Charles University

a. CDNO cooperates with other departments of FN Motol, 1st Faculty of Medicine and 2nd Faculty of Medicine, Charles University according to the current situation and condition of the patient, in order to meet the principles of "lege artis" and "evidence-based medicine".

b. CDNO is actively deepening existing cooperation and looking for opportunities to establish new ones with other workplaces.

10 Cooperation with other medical facilities, professional societies, organizations, etc.

a. Proton Therapy Czech (PTC) using proton radiotherapy in children.

b. Department of Pediatric Oncology, University Hospital Brno - cooperation on international protocols, creation of common national approaches to the diagnosis and treatment of pediatric brain tumors

11 International cooperation of individual workplaces forming the CDNO

The CDNO is integrated into international cooperation with the following entities through individual workplaces:

a. CDNO is part of the European Reference Network on Pediatric Cancer (hemato-oncology).

b. CDNO is part of the International Society for Pediatric Oncology (SIOP). Within the SIOP, the center participates in international phase III clinical trials within the optimization of treatment for individual diagnoses.

c. The CDNO is part of the Innovative Therapies for Childhood Cancer (ITCC), which has access to the latest treatments in Phase I and II clinical trials.

d. INFORM - molecular diagnostics and target search in patients with unfavorable prognosis.

e. EpiCARE (European Reference Network for Rare and Complex Epilepsy).

f. CDNO is actively deepening existing cooperation and looking for opportunities to establish new ones with other workplaces at the international level.

12 Development concept, future changes in the scope of care, event. investment plans

a. Promotion of CDNO within the Czech Republic and internationally through the media, internet, social networks and other media.

b. The CDNO is not a closed unit and is open to admission to other clinics and institutes.

c. CDNO is actively working on the introduction of new histopathological and molecular genetic diagnostic methods.

d. CDNO is actively working to acquire new and upgrade existing equipment needed in the diagnostic-therapeutic process.

e. CDNO seeks recognition of the center at the national level as a reference workplace for pediatric neurooncology.

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