On 2nd of February 2020, an eight-year-old boy from Singapore woke up with a severe headache followed by bouts of throwing up. Doctors in Singapore evaluated him and a MRI scan revealed a malignant tumour in the lower part of his brain. He was operated upon and the tumour was diagnosed as a medulloblastoma, WHO Grade IV type and the most common childhood brain cancer. Despite being Grade IV tumours, these children if treated appropriately can be cured completely with cure rates as high as 80-90%. Optimal treatment of these tumours however involves multi-disciplinary care.
The patient underwent surgery to remove the tumour but unless it was complemented with irradiation and chemotherapy the tumour could return, affecting the child’s spinal cord, said Dr. Rakesh Jalali, Medical Director of Apollo Proton Cancer Centre (APCC), Chennai. Surgery was just one part of the treatment, the doctor explained. The outcome of the treatment depended on the amount of residual tumour in the brain. Since the microscopic cells from the medulloblastoma tend to circulate in the cerebrospinal fluid, the entire spinal axis needed to be given radiation therapy. Proton beam therapy is the most sophisticated form of radiation therapy and is the treatment of choice for these tumours, as the therapy spares normal tissues significantly, including organs like thyroid, heart, lungs, aero-digestive track, kidneys, abdominal organs, gonads, etc. thereby limiting many late side effects related to radiation. The Singapore team contacted Dr Rakesh Jalali, one of the country’s foremost neuro-oncologists and Medical Director of Apollo Proton Cancer Centre (APCC) at Chennai, the only Proton facility operational in the entire South Asia and Middle East.
The boy with his mother and grandfather travelled from Singapore to India in February 2020, when the Covid-19 pandemic was on the rise in Asia. APCC had published guidelines for treatment of international patients during this pandemic. The boy and his attendants were asymptomatic at admission. After clearance from Infectious disease experts with all necessary precautions for personnel, the child underwent MRI and simulation for radiotherapy. The patient and his family were quarantined for a week before the child was taken up for proton therapy.
During simulation and the first week of radiation the child required sedation for treatment. However, after a week the child got acquainted to the environment and the radiation therapy team. He completed the remainder of treatment without any sedation. The boy completed the entire course of radiation therapy without any interruptions and completed his radiation therapy in the first week of April 2020. Due to the restriction in India, from March 23rd 2020 on domestic and international travel, the boy and his attendants were not able to travel back. The family wished to stay back in APCC for response evaluation and adjuvant chemotherapy.
The post-treatment MRI on April 30, 2020 came out clean with complete response to treatment. The APCC team and Singapore teams were in constant touch (digitally) to monitor his progress.
This success story is indeed a great example of close collaboration during current tough times
