Novel therapeutic approaches for pediatric diencephalic tumors: improving functional outcomes.

Pediatric diencephalic tumors represent a histopathologically and molecularly diverse group of neoplasms arising in the central part of the brain and involving eloquent structures, including the hypothalamic-pituitary axis (HPA), optic pathway, thalamus, and pineal gland. Presenting symptoms can include significant neurological, endocrine, or visual manifestations which may be exacerbated by injudicious intervention. Upfront multidisciplinary assessment and coordinated management is crucial from the outset to ensure best short- and long-term functional outcomes. In this review we discuss the clinical and pathological features of the neoplastic entities arising in this location, and their management. We emphasize a clear move towards 'function preserving' diagnostic and therapeutic approaches with novel toxicity-sparing strategies, including targeted therapies.

Advanced nursing practice: a review of scopes of practice in cancer care.

The establishment of advanced nurse practitioners (ANPs) has expanded considerably in recent years and shown to result in substantial contributions to numerous fields of health care. Due to advancements in treatments and innovations in medicine, patients with cancer are living longer, requiring a multifactorial holistic approach in which ANPs, due to their skills and knowledge, can be best utilised, as they are able to provide the expert care required at various stages of the patient journey. This article explores scopes of practice from ANPs working with oncology patients in a tertiary cancer centre, making explicit their roles, in addition to highlighting experienced challenges and future directions of care.

High grade gliomas in young children: The South Thames Neuro-Oncology unit experience and recent advances in molecular biology and targeted therapies.

High grade gliomas (HGG) have a dismal prognosis with survival rates of 15-35%. Approximately 10-12% of pediatric HGG occur in young children and their molecular biology and clinical outcomes differ from those arising at older ages. We report on four children aged <5 years newly diagnosed with non-brainstem HGG between 2011 and 2018 who were treated with surgery and BBSFOP chemotherapy. Two died of tumor progression. The other two are still alive without radiotherapy at 3.8 and 3.9 years from diagnosis: one of whom remains disease-free off treatment; and the other one, whose tumor harbored a KCTD16:NTRK2 fusion, went on to receive larotrectinib. Additionally we review the general management, outcomes and latest updates in molecular biology and targeted therapies for young children with HGG. Infant gliomas can be stratified in molecular subgroups with clinically actionable oncogenic drivers. Chemotherapy-based strategies can avoid or delay the need for radiotherapy in young children with HGG. Harnessing the potential of NTRK, ALK, ROS1 and MET inhibitors offers the opportunity to optimize the therapeutic armamentarium to improve current outcomes for these children.

Establishing content validity of the oral assessment guide in children and young people.

There is a need for accurate and consistent oral assessment to measure mucosal changes and oral complications associated with cancer therapies. Mucositis is an important and common side effect of cancer therapies that merits the identification of improved health-care interventions. Developing appropriate and reliable oral assessment instruments for use with children is relevant to the evaluation of these interventions. The purpose of this study was to determine the content validity of the oral assessment guide (OAG) in children: an instrument that was designed to objectively assess the physiological changes of the oral cavity following administration of chemotherapy and radiotherapy to adults. This process is considered to be most effective when undertaken systematically. A judgement quantification process was used with health care professionals in paediatric oncology to establish content validity of items (n=9) and instrument (n=10). A revised OAG more pertinent to children and young people was produced in the light of this process.