Treating institution and available pediatric neuro-oncology
resources
Results from the administered survey are available Table 1 . We
queried the hospital registry for new cancer diagnoses during our study
periods. The INEN had 450-500 new pediatric solid and hematological
cancer diagnoses per year, of which, 40-45 were CNS tumors. Between
1997-2007, there were four general pediatric oncologists who provided
care to all patients with hematological and solid tumors. The total
number of pediatric oncologists increased to eight during the second
period at INEN. There were three neurosurgeons at INEN prior to 2008 and
five general neurosurgeons during the second time period, however, none
had pediatric subspecialty training. Brain and spine MRIs were not
routinely obtained prior to surgery nor within 48 hours of surgery.
During the first time period there was no MR imaging available at INEN,
thus, MR imaging was obtained at private imaging centers, though
availability, insurance issues, and the prohibitive out of pocket costs
delayed imaging 2-3 months after surgery. The INEN acquired on-site MR
imaging in 2008, after which, the delay in obtaining post-operative MRI
in the second period decreased to approximately one month. There were
ten radiologists on staff prior to 2008 which increased to fifteen
radiologists after 2008. Three radiologists concentrated on CNS tumor
imaging. There were ten pathologists at the INEN prior to 2008 with one
trained in neuropathology, the number of both increased to 12 and two
respectively after 2008. The availability of antibodies for
immunohistochemistry are describe in Supplemental Table 1 .
Lastly, there were one radiation oncologists dedicated to
neuro-oncologic radiation therapy for children and adults. Radiation
therapy was delivered via photon radiation therapy throughout these
study periods, intensity-modulated radiation therapy was introduced in
2014.