CR-24: A 5-YEAR UPDATE REPORT OF A NATIONAL, VIRTUAL, INTERDISCIPLINARY ENDEAVOUR TO IMPROVE OUTCOMES FOR CHILDREN WITH HYPOTHALAMIC PITUITARY AXIS TUMOURS (HPATS) USING MULTI-SITE VIDEO CONFERENCING

BACKGROUND: HPAT's are rare and carry high neuroendocrine morbidity. Without systematic evidence, optimal management is unknown and varies with local experience. We hypothesised that wider interdisciplinary consultation amongst centres with pituitary (paediatric and adult) medical and surgical expertise, paediatric neurosurgery and oncology, enhances decision making and improve outcomes. METHOD: Delivered monthly by GOSH via multisite video conferencing, and piloted by 3 national centres since 2011, HPAT has discussed 125 complex cases (including 25 reviews) from 15 national and 3 international tertiary centres. Management plans were formulated for refractory cystic craniopharyngiomas (26%), pituitary adenomas (24%), idiopathic thickened pituitary stalk,TPS (18%), cysts (11%), suprasellar gliomas (6%), germinomas (6%), astrocytomas/glioneuronal tumour/meningioma (5%), hypothalamic hamartomas (2%) and congenital lesions (2%). RESULTS: In 16 cases, proposed management was significantly altered. One child, whose post transphenoidal surgery bone spicules were misinterpreted as residual craniopharyngioma, avoided scheduled radiation. 11 pituitary ‘masses’ were declared normal, 2 bilateral adrenalectomies for Cushings's syndrome, later diagnosed as ACTH pituitary microadenoma and carcinoid tumour, were halted and 3 refractory craniopharyngiomas received intracystic interferon(2) or systemic PCV chemotherapy(1). 5 centre experience audits and 3 HPAT outcome audits {craniopharyngiomas (4), adenomas (1), TPS (1), germinomas (1) and optic gliomas(1)} were presented internationally. CONCLUSION: A specialist interdisciplinary virtual MDT for discussion of complex HPAT tumours is welcomed, changes management through shared dialogue, knowledge and audit, and centralizes decision making without centralizing care. It has directly resulted in an ongoing endeavour to publish interdisciplinary national consensus management guidance by 2017.