required PPC services while 58% of them were referred for Physiotherapy services. Those not referred were primarily more stable for short-PICU-stay monitoring. The highest referrals (91.2%) were for respiratory and pain management while early mobilization was the 2nd-highest referral (75.4%), followed by the services for seating and ambulatory equipment prescription (51%). Personalized family support accounted for 35.1% of the referral, in which multidisciplinary pre-discharge plan and caregivers' empowerment program including home respiratory care, strategies for symptomatic relief. Co-jointed home visits were carried out to facilitate safe home discharge. Physiotherapists also provided support for early community integration e.g., outdoor visits. CONCLUSIONS:This review presents a comprehensive multidisciplinary PPR for patients receiving PPC services in PICU. The teamwork successfully initiates the steps for structured PPR, aiming at providing both children and their family a meaningful journey.

Background: We report demographic profile and our initial experience of treating children and young adults with image guided pencil beam scanning proton beam therapy (PBS-PBT) at our centre. Material and methods: All patients younger than 25 years, consecutively treated with PBT based on a multi-disciplinary tumor board decision were analyzed. Patients were treated under daily on-board kilovoltage x-ray and/or cone beam CT scan guidance. The demographic profile, treatment characteristics and the acute toxicities were reported. Patient and treatment related factors and their association with acute toxicities were analyzed using univariate and multivariate analysis. Results: Forty-seven patients {27 with central nervous system(CNS) and 20 with non-CNS tumors} with a median age of 9 years were evaluated. Most common diagnoses were ependymoma, rhabdomyosarcoma and glioma. Median dose delivered was 54.8CGE(40-70.4) to a median clinical target volume of 175cc (18.7-3083cc) with 34% requiring concurrent chemotherapy(CCT). Acute grade-2 and 3 dermatitis, mucositis, and hematological toxicity was noted in 45% and 2%; 34% and 0%; 38% and 30%; respectively. Grade-2 fatigue was noted in 26%. On univariate analysis, CCT(p=0.009) and cranio-spinal irradiation(p<0.001) were associated with grade-2 or more hematological toxicity in patients with CNS tumors. Among non-CNS tumors, clinical target volume more than 150cc was associated with grade-2 or more fatigue(p=0.017). Conclusions: The demographic pattern of patients treated with PBT at this new and only centre in the region was similar to previously published literature. Image guided PBS-PBT resulted in acceptable acute toxicities both among children with CNS and non-CNS tumors.

We present our experience in the management of children with inflammatory myofibroblastic tumor, a total of five children with two presenting with superior mediastinal syndrome and three with abdominal disease. We treated all children with a low-dose oral chemotherapy protocol, including prednisolone, 6-mercaptopurine, methotrexate, and celecoxib. Children with the mediastinal disease showed complete response with chemotherapy alone, while the child with sigmoid polyp is in remission with the chemotherapy post complete excision. We commenced two children with abdominal disease on crizotinib due to local recurrence with an adequate response. Long term follow-up and prolonged therapy are essential to sustain remission.