Traditional and complementary medicine (T&CM)strategies are frequently used by children with cancer alongside conventional medical treatments. However, there is little information about how and why they use it with conventional treatment. Therefore, the aim of this study was to explore the prevalence and patterns of T&CM use among children with cancer in a primary referral cancer center in Jordan

Abstract
Background. The prognosis for Li–Fraumeni syndrome (LFS) patients with medulloblastoma (MB) is poor.
Comprehensive clinical data for this patient group is lacking, challenging the development of novel therapeutic
strategies. Here, we present clinical and molecular data on a retrospective cohort of pediatric LFS MB patients.
Methods. In this multinational, multicenter retrospective cohort study, LFS patients under 21 years with MB and class 5
or class 4 constitutional TP53 variants were included. TP53 mutation status, methylation subgroup, treatment, progression
free- (PFS) and overall survival (OS), recurrence patterns, and incidence of subsequent neoplasms were evaluated.
Results. The study evaluated 47 LFS individuals diagnosed with MB, mainly classified as DNA methylation subgroup
“SHH_3” (86%). The majority (74%) of constitutional TP53 variants represented missense variants. The 2- and
5-year (y-) PFS were 36% and 20%, and 2- and 5y-OS were 53% and 23%, respectively. Patients who received postoperative
radiotherapy (RT) (2y-PFS: 44%, 2y-OS: 60%) or chemotherapy before RT (2y-PFS: 32%, 2y-OS: 48%) had
significantly better clinical outcome then patients who were not treated with RT (2y-PFS: 0%, 2y-OS: 25%). Patients
treated according to protocols including high-intensity chemotherapy and patients who received only maintenancetype
chemotherapy showed similar outcomes (2y-PFS: 42% and 35%, 2y-OS: 68% and 53%, respectively).
Conclusions. LFS MB patients have a dismal prognosis. In the presented cohort use of RT significantly increased
survival rates, whereas chemotherapy intensity did not influence their clinical outcome. Prospective collection of
clinical data and development of novel treatments are required to improve the outcome of LFS MB patients.

Abstract
Background Substantial progress has been achieved in managing childhood cancers in many high-income countries
(HICs). In contrast, survival rates in lower-middle-income countries (LMICs) are less favorable. Here, we aimed
to compare outcomes and associated factors between two large institutions; Egypt (LMIC) and Germany (HIC).
Methods A retrospective review was conducted on newly diagnosed children with cancer between 2006 and 2010
in the departments of pediatric oncology at the South Egypt Cancer Institute (SECI) (n = 502) and the University
Hospital of Cologne-Uniklinik Köln (UKK) (n = 238). Characteristics including age, sex, diagnosis, travel time from home
to the cancer center, the time interval from initial symptoms to the start of treatment, treatment-related complications,
compliance, and outcome were analyzed. A Cox proportional hazards regression model was applied to investigate
the influence of risk factors.
Results The most common diagnoses in SECI were leukemia (48.8%), lymphomas (24.1%), brain tumors (1%),
and other solid tumors (24.7%), compared to 22.3%, 19.3%, 28.6%, and 26.5% in UKK, respectively.
Patients from SECI were younger (5.2 vs. 9.0 years, P < 0.001), needed longer travel time to reach the treatment center
(1.44 ± 0.07 vs. 0.53 ± 0.03 h, P < 0.001), received therapy earlier (7.53 ± 0.59 vs. 12.09 ± 1.01 days, P = 0.034), showed
less compliance (85.1% vs. 97.1%, P < 0.001), and relapsed earlier (7 vs. 12 months, P = 0.008). Deaths in SECI were more
frequent (47.4% vs. 18.1%) and caused mainly by infection (60% in SECI, 7% in UKK), while in UKK, they were primarily
disease-related (79% in UKK, 27.7% in SECI). Differences in overall and event-free survival were observed for leukemias
but not for non-Hodgkin lymphoma.
Conclusions Outcome differences were associated with different causes of death and other less prominent factors.
Keywords Cancer, Children, Lower-middle income country, Problems, Survival

Simple Summary: Multimodal treatment of nasopharyngeal carcinoma (NPC) in children and
young adults with induction chemotherapy, followed by radiochemotherapy and interferon-β (IFN-
β) maintenance, has been successfully applied in studies NPC-91 and NPC-2003 of the German Society
of Pediatric Oncology and Hematology (GPOH). We, here, present updated survival rates of
the NPC-2003 study cohort after longer follow-up and include 21 additional patients recruited after
closure of the study and treated as per the NPC-2003 study protocol (interim cohort) in our survival
analysis. Survival rates remain high after extended follow-up and in the larger cohort with EFS and
OS of 94% and 97%, respectively, reinforcing the high antitumor efficacy of this multimodal treatment
concept. Seven patients with CR after induction therapy received a reduced radiation dose of
54 Gy, and none of them relapsed. Thus, the reduction of radiation dose seems feasible and has the
potential to reduce treatment-related late effects in this vulnerable population.
Abstract: Nasopharyngeal carcinoma (NPC) in children and young adults has been treated within
two consecutive prospective trials in Germany, the NPC-91 and the NPC-2003 study of the German
Society of Pediatric Oncology and Hematology (GPOH). In these studies, multimodal treatment
with induction chemotherapy, followed by radio (chemo)therapy and interferon-beta maintenance,
yielded promising survival rates even after adapting total radiation doses to tumor response. The
outcome of 45 patients in the NPC-2003 study was reassessed after a median follow-up of 85 months.
In addition, we analyzed 21 further patients after closure of the NPC-2003 study, recruited between
2011 and 2017, and treated as per the NPC-2003 study protocol. The EFS and OS of 66 patients with
locoregionally advanced NPC were 93.6% and 96.7%, respectively, after a median follow-up of 73
months. Seven patients with CR after induction therapy received a reduced radiation dose of 54 Gy;
none relapsed. In young patients with advanced locoregional NPC, excellent long-term survival
rates can be achieved by multimodal treatment, including interferon-beta. Radiation doses may be
reduced in patients with complete remission after induction chemotherapy and may limit radiogenic
late effects.

ABSTRACT
Noncompliance with therapy is a big obstacle to successful therapy.
We aimed to evaluate the prevalence and risk factors affecting the
compliance of pediatric cancer patients with therapy in a tertiary care
center far away from the capital in a lower-middle income country
(LMIC). A retrospective cohort study of reports of all pediatric cancer
patients who were diagnosed and started treatment between 2006
and 2010 at South Egypt Cancer Institute (SECI) was done. The following
data were collected: Age, sex, diagnosis, compliance with therapy,
and data on potential risk factors that might affect compliance,
including time duration of travel from the patient’s home to SECI,
time lag between the first symptom until the first visit to SECI and
until the start of treatment, results of reevaluation after the initial
course of therapy, and therapy-related severe adverse events.
Noncompliance with therapy was defined as when patients missed
their determined therapy appointment for one week or more or
abandoned therapy. This study included 510 patients. Eighty-three
(16.3%) were non-compliant, as forty patients missed their therapy
appointment (7.8%), and 43 abandoned further therapy (8.4%).
Noncompliance was found to be more prevalent among patients with
solid tumors. Non-compliant patients suffered a significantly higher
relapse rate (47.7% vs. 11.2% in compliant patients, p < .001).
Unfortunately, 75% of the abandoned patients who returned for further
therapy suffered a relapse. Noncompliance with treatment is still
a big problem facing cancer management in LMICs.

Abstract
Introduction
Children with suspected cancer may succumb to their bad condition shortly after admission,
even before a definitive diagnosis can be reached. We aimed to address the issue of
delayed presentation and early deaths among children suspected of having cancer. We
analyzed also the types and causes of mortalities across different tumor types.
Materials and methods
A retrospective review of reports from newly admitted patients between 2006 and 2010 at
the pediatric oncology department of the South Egypt Cancer Institute (SECI) was done.
Parameters included age, gender, diagnosis, symptoms, the interval between initial symptoms
and the first visit to SECI, the duration from admission to death, and the cause of
death.
Results
Among the 502 patients with confirmed malignancies, 238 (47.4%) succumbed. Causes of
death were predominantly treatment-related mortalities (TRM) (66%). Mortalities within
hematological malignancies were mainly TRM (81%), whereas solid tumors were primarily
disease-related (70%), p <0.0001. The leading causes of TRM was infection (60%).
About 5% of patients experienced early death within 48 hours after presenting to SECI.
The mean duration from initial symptoms to the first SECI visit was 67 days, and the period
from admission to death averaged 27 hours. Common initial symptoms included abdominal
swelling (29.6%), or fever (26%). The leading causes of death were respiratory failure
(29.6%), tumor lysis syndrome (22%), or septicemia (22%).

Conclusions
Delayed presentation leading to early deaths poses a significant obstacle to the successful
treatment of childhood cancers. Early diagnosis and improved supportive care are essential
to enhancing the overall survival, particularly in patients with hematologigical malignancies.

Abstract
Background and purpose: The use of traditional and complementary medicine (T&CM)
is common in children with cancer globally.We aimed to assess the prevalence, types,
reasons, perceived effectiveness, and disclosure rate of T&CMuse among children with
cancer in Southern Egypt. We also investigated whether T&CM use contributed to
delays in initial presentation and treatment.
Materials and methods: A cross-sectional design was utilized. Data were collected via
an interviewer-administered questionnaire. Eligible children and their caregivers at
the South Egypt Cancer Institute were invited to participate.
Results: Eighty-six children completed the study (response rate = 86%). T&CM use
was reported by 52 (60.5%) patients, with six (11.5%) experienced delayed presentation.
The reasons for T&CM use were complementary for 37 (71%) and alternative for
15 (29%) of the participants. The types of T&CM used included herbal (63%), nutritional
(33%), witchcraft (29%), and religious (19%) therapies. Approximately 48% of
users employed multiple T&CM types. Family members recommended T&CM for 60%
of the users.Most patients (65%) perceived T&CM as effective, with 71% initiating its
use during the early phases of treatment. Almost all participants (98%) reported that
healthcare providers did not inquire about T&CM use. T&CM usage was more prevalent
among wealthier families (p=.023). There was no significant relationship between
T&CM use and patient gender, diagnosis, residence, or paternal educational level.
Conclusions: The significant utilization of T&CMamong childrenwith cancer highlights
the need for healthcare providers to engage in open and early discussions with families
regarding T&CM use.

Abstract
Objective: A childhood cancer diagnosis is a traumatic experience for patients and
their families. However, little is known about the effect on grandparents. We aimed
to investigate the negative psychosocial impact, coping strategies, and positive
outcomes of grandparents of childhood cancer patients in Switzerland.
Methods: We collected data using a semi‐structured interview guide and applied
qualitative content analysis.
Results: We conducted 20 interviews with 23 grandparents (57% female; mean
age = 66.9 years; SD = 6.4; range = 57.0–82.4) of 13 affected children (69% female;
mean age = 7.5 years; SD = 6.1; range = 1.0–18.9) between January 2022 and April
2023. The mean time since diagnosis was 1.0 years (SD = 0.5; range = 0.4–1.9).
Grandparents were in shock and experienced strong feelings of fear and helplessness.
They were particularly afraid of a relapse or late effects. The worst part for
most was seeing their grandchild suffer. Many stated that their fear was always
present which could lead to tension and sleep problems. To cope with these negative
experiences, the grandparents used internal and external strategies, such as
accepting the illness or talking to their spouse and friends. Some grandparents also reported positive outcomes, such as getting emotionally closer to family members
and appreciating things that had previously been taken for granted.
Conclusions: Grandparents suffer greatly when their grandchild is diagnosed with
cancer. Encouragingly, most grandparents also reported coping strategies and
positive outcomes despite the challenges. Promoting coping strategies and providing
appropriate resources could reduce the psychological burden of grandparents and
strengthen the whole family system.