This update of the 2013 clinical practice guideline provides clinicians with guidance regarding the use of aprepitant and palonosetron for the prevention of acute chemotherapy-induced nausea and vomiting (CINV) in children. The recommendations were based on three systematic reviews. Substantive changes were made to the guideline recommendations including the inclusion of palonosetron to the 5-HT antagonists recommended for children receiving highly emetogenic chemotherapy (HEC) and the recommendation of aprepitant for children 6 months of age or older receiving HEC. To optimize CINV control in children, future work must focus on closing critical research gaps.

This mixed methods pilot study evaluated the effects of the creative arts therapy (CAT) on the quality of life (QOL) of children receiving chemotherapy. A 2-group, repeated measures randomized design compared CAT with a volunteer's attention (n = 16). Statistical analysis of the randomized controlled phase of the study suggested an improvement in the following areas after the CAT: parent report of child's hurt (P = .03) and parent report of child's nausea (P = .0061). A nonrandomized phase, using a different instrument showed improved mood with statistical significance on the Faces Scale (P < .01), and patients were more excited (P < .05), happier (P < .02), and less nervous (P < .02). Provider focus groups revealed positive experiences. Case studies are included to exemplify the therapeutic process. With heightened interest in complementary therapy for children with cancer, future research with a larger sample size is needed to document the impact of incorporating creative arts into the healing process.

Background High-dose chemotherapy(HDC) strategies were developed to avoid unacceptable neurotoxicity associated with craniospinal irradiation in infants with embryonal brain tumors. However, the impact of molecular and pathology characterization in such approaches and long-term outcome have not been widely described in young children. Methods We retrospectively collected information from seven North American institutions, on young children with medulloblastoma treated with sequential HDC, as per the CCG 99703 protocol. Data collected included clinical presentation, histology, molecular subgroup, irradiation, ototoxicity, and neurocognitive evaluations. Results The cohort included 53 patients diagnosed at a median age of 24 months (2.9–63.2). Seventeen patients(32.1%) had nodular desmoplatic medulloblastoma, all belonging to the Sonic Hedgehog subgroup(SHH), as did 30% of classic medulloblastoma. The 5-year progression free(PFS) and overall survival(OS) was 69.6%(±6·9%) and 76.1%(±6.5%) respectively. Seventeen(32.1%) patients received irradiation(RT), (9 adjuvant RT). Patients with SHH and group 3 medulloblastoma had a 5-year PFS of 86·2%(±7.4%) and 49·1%(±14%) respectively(p=0.03). The 5-year PFS radiation free for group 3 MB was 46.4%. Patients with macroscopic metastasis(M2, M3) had a worst survival. Fifteen(45.5%) patients had significant ototoxicity,. Mean FSIQ for 24 survivors was 91.6(range 52–119). Conclusion This HDC strategy led to an encouraging OS while only 20% of the patients received adjuvant RT. SHH medulloblastoma, irrespective of histological subgroup had an excellent outcome. Such intensive therapy may not be needed for this subgroup. Patients with classic histology or group 3, had an encouraging PFS of 58% and 46.4% respectively in absence of adjuvant RT. The neurocognitive profile of the survivors appears to be within the normal range.

Radiation-induced glioblastomas (RIGs) represent a significant proportion of glioblastomas (GBMs) seen in children and young adults and manifest poor prognosis. Little is known about their underlying biology, although limited studies have suggested no unique histologic or cytogenetic characteristics to distinguish them from de novo GBMs. In this study, we confirmed that a series of 5 RIGs showed no unique histologic or cytogenetic features compared with de novo pediatric GBMs, prompting us to further investigate RIGs using gene expression microarray profiling and Western blot analysis. Despite the inability of histologic and molecular genetic studies to identify distinguishing features between RIGs and pediatric GBMs, gene microarrays suggested significant differences between these 2 tumor types, at least those occurring in pediatric patients. Pediatric RIGs show greater homogeneity of gene expression than do de novo pediatric GBMs. Greater overlap was detected in gene expression patterns between RIGs and pilocytic astrocytomas than between RIGs and GBMs, medulloblastomas, ependymomas, atypical teratoid rhabdoid tumors, or rhabdomyosarcomas, suggesting a common precursor cell for RIG and pilocytic astrocytoma. Western blot analyses confirmed that ErbB3, Sox10, and platelet-derived growth factor receptor-alpha proteins were consistently expressed in RIGs but rarely in pediatric GBMs.