If you want the present to be different from the past, study the past.
Tumours of the nervous system are fascinating. They affect all ages, right from the infants, children, adolescents, adults and the old. From a histopathology perspective, these tumours can be benign and indolent, locally aggressive and some of them very malignant. Tumours such as meningiomas and pituitary adenomas may be so slow growing and causing no symptoms whatsoever that they may well be not diagnosed at all or diagnosed only as an incidental finding (incidentilomas), yet sometimes these very tumours may exhibit a more aggressive form and cause many forms (and intensity) of neurological deficit to the patient. Primary parenchymal tumours of the central nervous system such as gliomas are very common tumours and again constitute such an extreme and interesting varied histological spectrum. On one hand, they could be again relatively benign looking such as pilocytic astrocytomas (and indeed others like DNET, SEGA etc) with almost complete cure rates following appropriate treatment (frequently a surgical resection). On the other hand, we have the most virulent and aggressive tumours such as glioblastomas (indeed perhaps the most aggressive in the entire oncology spectrum), which remains largely incurable. In between these two extreme forms, we have low grade gliomas (diffuse fibrillary astrocytomas and oligodendrogliomas), which are perhaps the most unpredictable of the lot with a very diverse course and in all respects potentially malignant as a majority of them eventually transform into a high grade glioma and hence only a few real long term cures. To make the situation even more interesting, seemingly low grade tumours in critical sites such as the pons (even if histologically pilocytic but involving diffusely) behave rather in a malignant fashion and continue to pose one of the most formidable challenges in our practice. Recent advances in the molecular, genetic and microenvironmental level have given us some rare insights, yet present to us a vast unexplored vistas of aetiopathogenesis of these tumours. Clinical spectrum of these patients also throws up very diverse symptomatology and presentation depending upon the age, site of the tumour, type of the tumour, histological type, grade, etc etc. In this context, therefore, issues of tumour control, survival, functional status, general and neurological performance and quality of life are crucial and mandate an intensives insights and understanding the various facets and nuances of management. Against this background, it is not difficult to recognise that indeed the optimal management paradigms for patients with these tumours involve many disciplines and various fields of neurosciences. Experts from neurosurgery, neurology, radiation oncology, medical and paediatric oncology form the fundamental core team of clinicians. Experts from neuropathology and neuroradiology are absolutely essential right from the diagnosis to interpretation on follow up and recurrence, if any. Because of the unique (and often critical) anatomical and physiological aspects of the nervous system, tumours and sometimes treatment interventions can affect all ranges of functional aspects. Occupational therapist, physiotherapist, speech therapist, counsellors and psychologists constitute essential ancillary members of a comprehensive neurooncology team.
It is important therefore to also have an appropriate platform where members representing such diverse disciplines, yet sharing a common passion for neurooncology can come together. Associations and societies for providing this platform have been constituted in different parts of the world. Premier such societies include the Society for NeuroOncology (SNO) based in North America and the European Association of NeuroOncology (EANO). India represents an interesting canvas of varied cultural diversity. Not only is there so much diversity in the form of language, religions, food habits, climates, terrains, social practices, there is also a wide variety in economical status of its people. In the field of medicine too (as indeed in neurooncology), we have diversities in the availability and quality of care different parts of the country. One of the aims obviously would be to bring a kind of uniformity in the standards of care of various physicians and set ups. In these contexts, a few groups had been working in their respective areas and after a few discussions; the NeuroOncology Society of India (NOSI) was formed. It was officially launched on 29th February, 2008 during the Annual Evidence based Cancer Management Meetings organised by the Tata Memorial Hospital, Mumbai. The aims of the society are as follows:
- The Society shall be a non-profitable organization for promotion and advancement of scientific knowledge and research in central nervous system (CNS) and peripheral nervous system (PNS) tumours and increasing the awareness amongst both physicians and general public regarding the proper management of CNS and PNS tumours.
- Increase interdisciplinary interactions among Clinicians dealing with management of Neurological Tumours at National and International level.
- To bring uniformity in management through introduction of Evidence-Based Guidelines and management protocols for central nervous system (CNS) and peripheral nervous system (PNS) tumours.
- To encourage basic and clinical research in neurooncology and help in translation of laboratory discoveries to patient care.
- To assist Government and non-governmental agencies in all matters pertaining to CNS and PNS tumours.
- To increase public awareness about CNS and PNS tumours and actively promote continuing education to disseminate the state-of-art knowledge on the basic research and treatment inneurooncology.
- To protect and preserve the interest of its members.
A list of the executive committee is also displayed in this newsletter. We have attempted to give representation to all disciplines and all regions to have a comprehensive outlook. In our country, we have a large number of patients, excellent expertise, increasingly improving communication (and therefore much better follow up information) and perhaps more importantly, a growing recognition of generating world class basic, clinical and epidemiological data and NOSI hopefully would provide an appropriate forum to talk, deliberate, execute quality research. Let us all be hopeful that the Society delivers the planned objectives and may I request you all to kindly pitch in these endeavours. Participation from each and every one of you would be absolutely crucial for our success. Our ultimate goal of course, which goes without saying, is to help our patients and their families.
I look forward to your thoughts and suggestions for the society.