Pediatric brain tumors are the most common solid malignancies in children. Advances in the treatment of pediatric brain tumors have come in the form of imaging, biopsy, surgical techniques, and molecular profiling. This has led the way for targeted therapies and immunotherapy to be assessed in clinical trials for the most common types of pediatric brain tumors. Here we review the latest efforts and challenges in targeted molecular therapy, immunotherapy, and newer modalities such as laser interstitial thermal therapy.

129 Background: Neuroblastoma (NBL) is the most common extra-cranial solid organ malignancy in children. Although low and intermediate-risk patients have a survival of close to 90%, the same cannot be said for patients with high risk (HR) disease. In the last decade multi-modality treatment of HR NBL patients has been intensified to include chemotherapy, surgery, radiation, bone marrow transplantation and immunotherapy and has resulted in improved survival (Yu, 2009). Data regarding the medium to long-term side effects of this intensive multi-modality therapy is now being collected as the population of HR neuroblastoma survivors continues to grow. Methods: We retrospectively reviewed the clinical data of survivors of HR NBL treated at the Children’s Hospital of Illinois diagnosed since 2009 and evaluated the long-term side effects of survivors through 2015. Results: We found 14 NBL patients of whom 10 had HR disease. Four patients died of progressive disease. Therapy-related, long-term side effects occurred in 6 patients: hearing loss (n = 6), adrenal insufficiency (n = 2), focal nodular hyperplasia of the liver (n = 2), linear growth retardation (n = 1). No patient in our cohort developed thyroid or cardiac problems and no patient was diagnosed with a second malignancy in the 5 years of observation. Conclusions: While the improved outcomes seen in HR NBL patients is encouraging, we found in our small cohort hat survivors of multimodality therapy for high-risk neuroblastoma experience significant long-term effects of treatment which impact their quality of life as well as growth and development. As the number of NBL survivors increases our understanding of the long-term therapy related side effects will continue to improve. Larger longitudinal studies are needed to monitor for other possible side effects that may manifest overtime such as cardiomyopathy, disturbances in sexual development, fertility, intellectual function, learning problems and therapy related second malignancies later in life.

131 Background: The concept of pediatric hospice care is a natural progression of the hospice philosophy as it has been applied to adults, although, there are unique challenges presented by children. At our institution hospice service for children are offered by the adult team. We evaluated the number of children with cancer eligible for hospice between July 2009 and May 2015 and also explored the barriers that prevented hospice enrollment and the experiences of families, and hospice staff. Methods: Retrospective Review, Programmatic Initiative. Results: Thirty-two children diagnosed with cancer died in a 6 year period. Diagnosis breakdown was: Solid tumors 17/32 (53%), brain tumors 8/32 (25%), leukemia/lymphoma 6/32 (19%), 1 rare hematology condition. Twenty-one patients (65%) were 0 – 9.99 years and 11(35%) between 10 – 19.99 years. Fifteen patients (47%) were enrolled in hospice and all died at home except one. 18/32 (56%) children died in the hospital, of those 10/18 (55%) their parents chose the hospital as the site for their children passing, 6/18 (33%) died from an unexpected acute episode that resulted in death, and 2/18 (11%) patients had an acute episode that lead to un-planned patient hospitalization. The identified barriers to establishing and delivering hospice care were: a) family unwillingness to work with the hospice team b) family desire to have the patient die in the hospital c) hospice services not available in the patient’s residential area and, d) low level of comfort in the care of young children on the part of the hospice staff. Families expressed mixed feelings regarding hospice services. Conclusions: Hospice services for children with cancer are underutilized. There are family, institutional and community barriers to hospice enrolment for children with cancer. The great majority of patients still die in the hospital. We propose to improve our regional pediatric hospice service by strengthening collaboration between pediatric oncology, palliative care and hospice to better serve children with cancer at the end of life with a programmatic initiative involving the oncology team. We aim to evaluate the impact of this initiative on families, hospice staff and the oncology team.