Long-term survival after reduced-dose radiotherapy in pediatric nasopharyngeal carcinomaWen Shen Looi, MBBS, FRCR, FAMS1, Ah Moy Tan, MBBS2, Shui Yen Soh, MBBS2, Yoke Lim Soong, MBBS1, Ru Xin Wong, MBBS11Division of Radiation OncologyNational Cancer Centre Singapore2Haematology/Oncology ServiceKK Women’s and Children’s Hospital

Introduction Pediatric oncology patients are reportedly at risk for progression to severe Coronavirus disease-2019 (COVID-19) infection. Data on the safety and clinical effectiveness of remdesivir in children with cancer remains scarce. The main aims of this study were to describe COVID-19 infection in this cohort and to evaluate the utility of remdesivir treatment in terms of the time to viral clearance and its safety profile. Methods This was a retrospective observational cohort study of pediatric oncology patients ≤18 years of age with SARS-CoV-2 polymerase chain reaction (PCR) confirmed infection. Patients were admitted to KK Women’s and Children’s Hospital from 1 st November 2021 to 31 st March 2022. Clinical data, investigations and laboratory tests results were collected. Results Eighteen patients were included. Median age was 6.5 years (IQR: 4.64 – 9.83), and there were 13 males (72.2%). The immunosuppressive status of the cohort was: severe (n = 3, 22.2%), moderate (n = 9, 50.0%) and low (5, 27.8%). All patients had mild COVID-19 infection, and there were no COVID-19 attributed deaths. Remdesivir was initiated in four patients. We did not detect any benefit in terms of time to viral clearance or SARS-CoV2 PCR cycle threshold ≥25 between the treated versus non-treated groups. Remdesivir was well tolerated with no safety concerns. Conclusion Our cohort of immunocompromised pediatric oncology patients all had mild clinical COVID-19 with no directly attributable morbidity and mortality. In four patients, treatment with remdesivir was safe but did not lead to early viral clearance.

Background Pediatric solid tumors require coordinated multidisciplinary specialist care. However, expertise and resources to conduct multidisciplinary tumor board (MDTB) meetings are lacking in low- and middle-income countries (LMICs). We aimed to profile practices and perceptions on MDTBs among pediatric solid tumor units (PSTUs) in Southeast Asian LMIC countries. Methods Using online survey forms, availability of specialty manpower and MDTBs among PSTUs was first determined. From the subset of PSTUs with MDTBs, 1 pediatric surgeon and 1 pediatric oncologist from each center were queried using 5-point Likert scale questions adapted from published questionnaires. Results In 37/46 (80.4%) identified PSTUs, pediatric-trained oncologists, surgeons, radiologists, pathologists, radiation oncologists, nuclear medicine physicians and nurses were available in 94.6%, 91.9%, 54.1%, 40.5%, 29.7%, 13.5% and 81.1% of PSTUs, respectively. Availability of pediatric-trained surgeons, radiologists and pathologists were significantly associated with existence of MDTBs (p=0.037, 0.005, 0.022 respectively). Among 43/48 (89.6%) respondents from 24 PSTUs with MDTBs, 90.5% of oncologists reported >50% oncology-dedicated workload versus 22.7% of surgeons. Views on benefits and barriers did not significantly differ between both groups. Majority agreed MDTBs helped improve accuracy of treatment recommendations and team competence. Complex cases, insufficient radiology and pathology preparation, and need for supplementary investigations, were the top barriers. Conclusions Availability of pediatric-trained subspecialists was a significant prerequisite for pediatric MDTBs. Most PSTUs lacked pediatric-trained pathologists and radiologists. Correspondingly, gaps in radiographic and pathological diagnoses were the commonest limitations. Greater emphasis on holistic multidisciplinary subspecialty development is needed to advance pediatric solid tumor care in Southeast Asia.