Retrospective analysis of combination carboplatin and vinblastine for pediatric low-grade glioma.

INTRODUCTION: Low-grade glioma (LGG) represent the most common pediatric central nervous system tumor. When total surgical resection is not feasible, chemotherapy is first-line therapy in children. Multiple pediatric LGG chemotherapy regimens have been investigated with variable 2-year event free survival (EFS) rates of 39-69%. To date, treatment of pediatric LGG with a carboplatin and vinblastine (C/VBL) chemotherapy regimen has only been evaluated in a phase 1 dose-finding study. METHODS: A retrospective review of pediatric patients with LGG who were treated with C/VBL at Children's Hospital of Colorado or Akron Children's Hospital from 2011 to 2017 was conducted. Data collected included patient demographics, tumor location, disease response, neurofibromatosis 1 (NF1) status, therapy duration and toxicities. Response to therapy was determined by objective findings on imaging and treating physicians' evaluation. RESULTS: Forty-six patients were identified for analysis, all of whom were chemotherapy-naive. Only five patients treated in this cohort had NF1. BRAF fusion was identified in 65% (22/34) of tested tumors. Best therapy response was partial response in nine patients and stable disease in twenty-five patients. Twelve patients had progressive disease. One-year, 3-year, and 5-year EFS probabilities for all patients were 69.6%, 39.4%, and 34.5%, respectively. Nine patients had admissions for febrile neutropenia and seven patients experienced one delay in chemotherapy due to neutropenia. Only two patients had to discontinue this chemotherapy regimen because of treatment-related toxicities [carboplatin allergy (n = 1) and vinblastine neuropathy (n = 1)]. CONCLUSION: C/VBL achieves similar EFS rates to other single-agent and combination cytotoxic chemotherapy regimens for pediatric LGG with manageable toxicities.

The effects of educational interventions and the COVID-19 pandemic on the time to diagnosis in pediatric patients with primary central nervous system tumors.

Background: Primary central nervous system tumors are a leading cause of death and disability amongst pediatric cancer patients. Akron Children's Hospital published data in 2018 on response time for brain tumor diagnosis and implemented components of an established program to decrease diagnostic delays and thereby reduce tumor- and treatment-related morbidities. This study evaluates if there was an improvement in the total diagnostic interval (TDI, time from symptom onset to diagnosis) after provider education. During the study, the COVID-19 pandemic forced alterations in care delivery. The impact this had on the TDI was also assessed. Methods: A retrospective chart review was performed, and patients were separated into 2008-2017 (historical) and 2018-2021 (posteducation) groups to assess the effect of educational interventions on TDI. The posteducation cohort was analyzed separately to assess the impact of COVID-19 pandemic. Results: The 85 patients studied in the post-education group showed a median TDI of 31 days. Though not statistically significant (P = .939), this represents an 11-day decrease in median TDI compared to the historical group (42 days). In addition, the posteducation group showed an increase in the average number of healthcare provider visits (HCP, 2.4 historical to 3.2 posteducation, P = .009). The pre-COVID-19 group (median TDI 43.5 days) did not differ statistically from the post-COVID-19 group (30-day median TDI). Conclusion: The nonsignificant decrease in TDI and concurrent increase in HCP visits after implementation of education suggests a potential gap amongst providers in working-up primary CNS tumors. These results will influence expansion of education to further improve TDI.

Recollection of Fertility Discussion in Adolescent and Young Adult Oncology Patients: A Single-Institution Study.

Purpose: With increasing number of childhood cancer survivors, focus has recently shifted to improving future quality of life and long-term complications, such as infertility. Despite national guidelines, fertility preservation is discussed in less than half of the eligible patients. In this study, we sought to discover if education gaps regarding fertility exist within our practice, in efforts to address these gaps to improve the quality of cancer care we provide. Methods: A retrospective electronic survey was administered to eligible adolescent and young adult oncology patients. Results: Of the 63 patients approached, 47 responded to the survey. Before initiation of antineoplastic therapy, 22/47 (46.8%) stated that they were concerned about their fertility to some degree; however, only 11/47 (23.4%) report pursuing fertility preservation. When asked why they decided against steps to preserve fertility, 15/36 (41.6%) reported that they did not know they had options. Of all patients that completed the survey, 28/47 (59.6%) requested additional information regarding their fertility. Conclusion: Majority of respondents recall having a discussion regarding the impact of antineoplastic therapy on their fertility at the time of diagnosis, which was initiated by their oncologist. However, less than half reported satisfaction with these discussions. Although this study did not demonstrate statistical significance, it has resulted in development of a multidisciplinary oncofertility team for fertility preservation referrals, at our institution, as well as education materials for all newly diagnosed oncology patients.