Background The COVID-19 pandemic had led the Indian government to announce a nationwide lockdown on the 23rd of March 2020. This study (InPOG-ACC-20-04) aimed to explore the impact of this on the accessibility of care of children with cancer in India and to see strategies adopted by hospitals for service delivery during the lockdown. Procedure Weekly average childhood cancer (<18 years) patient registrations during pre-lockdown period (Jan 1st, 2020 to March 23rd 2020) were compared with the post-lockdown period (Mar 24th, 2020 to May 31st, 2020). The effect on the scheduled treatment was investigated for the post-lockdown period. A survey of health care providers was conducted to determine centres’ strategies to deal with the effect of COVID-19. Results In 30 centres participating in this study, 1146 childhood cancer patients were registered from Jan 1st, 2020 to May 31st 2020. The weekly average patient registration was 67.3 pre-lockdown and 35.5 post-lockdown which was a decline of 47.3% with travel distance being a factor. While most centres experience this decline, there were a few who saw an increase in patient registrations. Of those patients scheduled for treatment during the post-lockdown period, 36.1% experience delays in one or more modalities. Centres adopted several strategies to including modifications to treatment protocols, increased use of growth factors, and increased support from social organisations. Conclusion Our multicentre study from India suggests that the COVID19 pandemic and the lockdown impacted two out of three children with cancer. The effect of this on survival remains to be established.

Introduction: The InPOG-HL-15-01, a multi-centric prospective study used a risk-stratified and response-based approach with a doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) backbone to treat children with newly diagnosed Hodgkin Lymphoma (HL) and reduce the use of radiation therapy (RT). Children/adolescents with bulky disease or inadequate response at early response assessment (ERA) after 2 cycles of chemotherapy were assigned to receive RT. For ERA, positron emission tomography computed tomography (PET-CT) was recommended but not mandatory in view of limited access. This study aimed to compare the impact of using contrast enhanced computed tomography (CECT) vs PET-CT on treatment decisions and outcomes. Methodology: 396 patients were enrolled and 382 had an ERA at the assigned time point. Results: At ERA, satisfactory response was documented in 277/382 (72.5%) participants and this was significantly higher in PET-CT (151/186, 81.2%) as compared to CECT (126/196, 64.3%) respectively (p value<0.001). Amongst the 203 patients with non-bulky disease (wherein the indication for RT was entirely dependent on ERA), 96/114 (84.2%) and 61/89 (68.5%) patients achieved a satisfactory response according to the PET-CT and CECT (p value=0.008) respectively and hence a lesser proportion of patients in the PET-CT arm received RT. Despite a lower usage of RT the 5 year overall survival (OS) of both groups- ERA based on CECT (91.8%) vs PET-CT (94.1%) was comparable (p value=0.391) and so was the 5 year event free survival (EFS) (86.7 vs 85.5%, p value=0.724). Conclusion: Use of PET-CT as the modality for ERA is more likely to indicate a satisfactory response as compared to CECT and thereby decreases the need for RT in response-based treatment algorithm for HL afflicted children. The reduction in the application of RT did not impact the overall outcome and plausibly would lower the risk of delayed toxic effects.

Background: Recent SIOPEL studies have shown cisplatin monotherapy to be equally effective in management of Standard risk Hepatoblastoma (SRHB) as compared to PLADO. Aim: To study the chemotherapy, response and outcomes in children with SRHB in a Resource Challenged Nation (RCN). Material and Methods: A retrospective study was conducted and all children with SRHB who were treated by us from June 2007 to December 2017 were included. All patients with standard risk hepatoblastoma who had received at least 2 courses of chemotherapy were included. Data regarding the demographics, PRETEXT stage, chemotherapy, response to chemotherapy and outcomes were recorded. Kaplan Meier survival analysis was performed to calculate 5-year overall survival (OS) and event free survival (EFS). Results: Thirty-two children were included in the study. Nineteen children (59.4%) received Cisplatin monotherapy and of these 6 patients (all PRETEXT III) had poor response and were upgraded to PLADO. The remaining 13 (40.6%) received upfront PLADO. The 5-year OS and EFS was 100% in the monotherapy group (n=13), 92% and 69% in the upfront PLADO group (n=13), and 62% and 22% in the upgraded to PLADO group (n=6). Patients in upgraded to PLADO group had significantly lower 5-year EFS (70% vs 22%; p= 0.036) compared to upfront PLADO group. Conclusion: Two thirds of SRHB patients with PRETEXT stage III who received cisplatin monotherapy showed poor response and were upgraded to PLADO chemotherapy. These patients had a significantly poorer outcome compared to the rest of the cohort. PRETEXT stage III standard-risk hepatoblastoma may benefit from PLADO chemotherapy instead of cisplatin monotherapy.

Background and aims: Oral mucositis (OM) is common and distressing toxicity in children on chemotherapy. There is limited number of safe and effective therapeutic options available for OM. Ketamine oral rinse has shown promising results in few studies in adults. This randomized, double-blind placebo-controlled trial aimed to test the efficacy of ketamine mouthwash in reducing chemotherapy-induced severe OM pain in children. Methods: Children aged 8-18 years with severe OM were randomized to a single dose of ketamine mouthwash (4 mg/ml solution; dose 1 mg/kg) or a placebo. A sample size of 44 patients was determined. Pain score (6-point faces scale) was noted at baseline and 15, 30, 45, 60, 120, 180, and 240 min. The outcome variables were a reduction in pain score, need for rescue medications, and adverse events. Results: The baseline characteristics were comparable in the two groups. The mean OM pain at 60 min decreased by 1.64 points (CI 1.13-2.14) in the ketamine group and 1.32 points (CI 0.76-1.87) in the placebo group (p=0.425), with a group difference of 0.32 points. Rescue pain medication (at 60 min) was required in 13.6% in the ketamine group and 18.2% in the placebo group (p=1.000). There were no significant adverse events observed. Conclusions: Among children on cancer chemotherapy with severe OM, ketamine mouthwash at a dose of 1 mg/kg did not significantly reduce OM pain. It did not decrease the need for rescue pain medications. Further research is warranted to test higher doses of ketamine for a clinically significant effect.