Background Children with high-grade CNS cancers frequently experience malnutrition during treatment. We assessed the effects of proactive enteral tube (ET) placement/enteral tube feedings (ETF) on weight in infants/children with high-grade CNS tumors treated with aggressive chemotherapy. Methods We conducted a retrospective study of patients age 0 to 19 years treated for new high-grade CNS tumors between 2002 and 2017 at a tertiary pediatric hospital system. Patients underwent placement of proactive ET (≤ 31 days postdiagnosis; n = 45), rescue ET (> 31 days, due to weight loss; n = 9), or no ET (n = 18). Most received surgically placed ET (98%), with percutaneous endoscopic gastrojejunostomy or gastrojejunostomy tubes favored to allow jejunal feeding. The majority of patients with ET used ETF (91%). Using mixed-effects regression models, we examined differences in mean weights between ET/ETF groups across the first year of treatment. We also evaluated observed weight changes. Results All infants (n = 22, median age, 1.5 years) had proactive ET placed and 21 of 22 used proactive ETF. Infants showed an initial increase in mean percentage weight change that eventually leveled off, for an estimated increase of 10.4% over the year. For the pediatric cohort (n = 50, median, 8.1 years), those receiving proactive ETF experienced weight increases (+9.9%), those with rescue ETF experienced an initial decline and eventually rebounded for no net change (0.0%), and those with no ETF demonstrated an initial decline that persisted (–11.9%; Pinteraction < .001). Analysis of observed weights revealed nearly identical patterns. Conclusions Proactive ETF was effective at maintaining weight and/or facilitating weight gain over the first year of treatment and was acceptable to patients/families.

Because children diagnosed with WNT-activated medulloblastoma have a 10-year overall survival rate of 95%, active long-term follow-up is critically important in reducing mortality from other causes. Here, we describe an 11-year-old adopted female who developed multiple pilomatrixomas 3 years after diagnosis of WNT-activated medulloblastoma, an unusual finding that prompted deeper clinical investigation. A heterozygous germline APC gene mutation was discovered, consistent with familial adenomatous polyposis. Screening endoscopy revealed numerous precancerous polyps that were excised. This case highlights the importance of long-term follow-up of pediatric cancer survivors, including attention to unexpected symptoms, which might unveil an underlying cancer predisposition syndrome.

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NEURO-ONCOLOGY • NOVEMBER 2017 ing transitions at enrolment, 2 weeks and 12 weeks. Outcomes of interest included: acceptability (primary); quality of life [patient (FACT-Br), carer (CQOLC)]; needs for support [patient (SCNS-SF34), carer (CNSAT)]; disease-related information needs (PINQ); and preparedness to care [carer (PCS)] (secondary). Descriptive statistics were used to assess acceptability outcomes. Differences in patient and carer outcomes before and after ICoPE were assessed using repeated measures ANOVA. RESULTS: Thirty two patients (53% male, mean age 60), and 31 carers (42% male) participated. I-CoPE was highly acceptable: 95% eligible patients enrolled, 27 (88%) contributing data until deterioration/death. Post I-cope: (1) Patients reported fewer information (p<.001, ƞ p 2 .33) needs and improvements in quality of life following their diagnostic hospitalisation (p<.003, ƞ p 2 .24), which were not sustained following radiotherapy. (2) Carers reported fewer unmet supportive care (p=.009, ƞ p 2 .21) and information needs (p<.001, ƞ p 2 .33), improved quality of life (p=.08, ƞ p 2 .11), and increased preparedness to care (p=.04, ƞ p 2 .13). CONCLUSION: A model of supportive care delivered based upon illness transitions is highly acceptable and suggests preliminary efficacy in some areas. Formal randomized studies are now required.