PURPOSE: As new evidence is available, the International Late Effects of Childhood Cancer Guideline Harmonization Group has updated breast cancer surveillance recommendations for female survivors of childhood, adolescent, and young adult cancer. METHODS: We used evidence-based methods to apply new knowledge in refining the international harmonized recommendations developed in 2013. The guideline panel updated the systematic literature review, developed evidence summaries, appraised the evidence, and updated recommendations on the basis of evidence, clinical judgement, and consideration of benefits versus the harms of the surveillance interventions while attaining flexibility in implementation across different health care systems. The GRADE Evidence-to-Decision framework was used to translate evidence to recommendations. A survivor information form was developed to counsel survivors about the potential harms and benefits of surveillance. RESULTS: The literature update identified new study findings related to the effects of prescribed moderate-dose chest radiation (10 to 19 Gy), radiation dose-volume, anthracyclines and alkylating agents in non–chest irradiated survivors, and the effects of ovarian function on breast cancer risk. Moreover, new data from prospective investigations were available regarding the performance metrics of mammography and magnetic resonance imaging among survivors of Hodgkin lymphoma. Modified recommendations include the performance of mammography and breast magnetic resonance imaging for survivors treated with 10 Gy or greater chest radiation (strong recommendation) and upper abdominal radiation exposing breast tissue at a young age (moderate recommendation) at least annually up to age 60 years. As a result of inconsistent evidence, no recommendation could be formulated for routine breast cancer surveillance for survivors treated with any type of anthracyclines in the absence of chest radiation. CONCLUSION: The newly identified evidence prompted significant change to the recommendations formulated in 2013 related to moderate-dose chest radiation and anthracycline exposure as well as breast cancer surveillance modality.

Background: Treatment summaries and a personalized survivorship care plans based on internationally approved, organ-specific follow-up care recommendations are essential in preserving the health and quality of life for cancer survivors. Cohorts made up of survivors of childhood cancer have made significant contributions to the understanding of early mortality, somatic late complications, and psychosocial outcomes among former patients. New treatment protocols are needed to enhance survival and reduce the potential risk and severity of late effects, and working with treatment databases is crucial in doing so. Construction and content: In the GOCE (Grand Ouest Cancer de l’Enfant [Western Region Childhood Cancer]) network, in a participative approach, we developed the LOG-after medical tool, on which health data are registered and can be extracted for analysis. Its name emphasizes the tool’s goal, referring to ‘logiciel’ (the French word for software) that focuses on the period “after” the acute phase. This tool is hosted on a certified health data server. Several interfaces have been developed that can be used depending on the user’s profile. Here we present this innovative co-constructed tool that takes national aspects into account, including the results of the feasibility/satisfaction study and its perspective. Utility and discussion: The database contains data relating to 2558 patients, with samples from 1702 of these (66.54%) being held in a tumor bank. The average year in which treatment started was 2015 (ranging from December 1967 to November 2022: 118 patients were treated before 2012 and registered retrospectively when seen in long-term follow-up consultations or for another cancer since November 2021). A short questionnaire was distributed to healthcare professionals using the tool (physicians and research associates or technicians, n = 14), of whom 11 answered and were all satisfied. Access to the patient interface is currently open to 124 former patients. This was initially offered to 30 former patients who were over 15 years old, affected by the disease within the last 5 years, and had agreed to test it. Their opinions were collected by their doctor by e-mail, telephone, or during a consultation in an open-ended question and a non-directive interview. All patients were satisfied with the tool, with interest in testing it in the long term. Some former patients found that the tool provided them with some ease of mind; one, for instance, commented: "I feel lighter. I allow myself to forget. I know I will get a notification when the time comes." Conclusions: Freely available to all users, LOG-after: (1) provides help with determining personalized survivorship care plans for follow-up; (2) builds links with general practitioners; (3) empowers the patient; and (4) enables health data to be exported for analysis. Database URL for presentation: https://youtu.be/2Ga64iausJE

Objectives: This study aimed to describe pregnancy and maternal outcomes according to radiation doses received to the uterus during photon beam therapy in the French Childhood Cancer Survivor Study (FCCSS) cohort. Methods: Of the 7670 5-years survivors, 1159 women treated by radiotherapy and with no hysterectomy, followed between 2006 and 2018 were included. Uterus dose were reconstructed within phantoms modelling patient’s anatomy in treatment position. A statistical analysis was performed including demographic information, treatment variables, and co-factors. Results: Among 1159 women, 297 (25.6%) had at least 1 pregnancy, of whom 105/297 (35.3%) had a uterine dose of Dmedian > 1Gy. The proportion of ectopic pregnancy, spontaneous and medical abortions was 20.3% (101/498) and increased to 39% if Dmedian_uterus > 20Gy, versus 12% reported in the French’s general population. When medical pregnancy terminations were excluded, significant associations with an increase in risks were found for women who were older than 40 at the time of pregnancy and Dmedian_uterus > 20Gy. Two women whose entire uterus received over 40 Gy had 1 pregnancy, resulting in a live birth. One woman passed away due to haemorrhage during delivery, treated at age 16 with D80%uterus = 35Gy. No other delivery-related deaths were reported. Conclusion: Assessing the dose to the uterus for pelvic irradiation treatments is necessary, and volume receiving 20 Gy should be minimized. Even if pregnancy is feasible after really high dose received on the uterus (Dmean > 40Gy), a close obstetrical monitoring is recommended, and home delivery should be contraindicated due to the risk of vital haemorrhage. Advances in knowledge: This article provides valuable data between radiation dose to the uterus and pregnancy outcomes.

Objective: Regarding the efficiency of Bu-Mel-based high-dose-chemotherapy (Bu-Mel-HDCT) and whole lung irradiation (WLI), the objective was to evaluate the efficiency and safety of this salvage sequence in Ewing sarcoma (ES) lung relapses. Methods: All eligible pediatric ES patients (1991–2020) identified in SFCE departments were retrospectively reviewed. Seven patients were (1) diagnosed with a pulmonary relapse, isolated or not, (2) naïve from both HCDT and WLI (3) treated by the salvage sequence of conventional chemotherapy, Bu-Mel-HDCT and WLI. The main endpoint was OS evaluation. WLI toxicities were scored using CTC-V5. Results: With a 13 years median follow-up (FU), 5/7 patients are alive and in complete remission. 10y-EFS is 71.4%. Three patients experienced transitory radio-induced pneumopathy (RIP). A patient developed RIP (gr.3) and finally progressive lung fibrosis leading to death. Conclusion: This study reports seven ES patients treated for lung metastatic relapses, using an aggressive strategy, with favorable survival long-term results which should be balanced with the risk of lung toxicity. Advances in knowledge: The approach of surgery, Bu-Mel HDCT followed by WLI can be discussed in selected ES patients with lung relapse, naive from HDCT or WLI, providing an optimal chemosensitivity. A special vigilance is necessary regarding the incidence rate of lung toxicity which can be mitigated by limiting the radiotherapy dose, and observing optimal timing of radiotherapy after HDCT.

The number of adolescent and young adult cancer survivors (AYACSs) is increasing due to advancements in therapies. Despite these improvements, 70% of survivors experience long-term side effects. This systematic review aims to identify digital tools that enhance the quality of life and well-being of AYACSs aged 15–29 years. The review was conducted using four databases: PubMed, Science Direct, Cochrane, and PsycINFO (OVID platform). Articles from bibliographic references of selected studies were also included if relevant. The search followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and included studies published between January 2014 and December 2024 that described digital tools focusing on quality of life and/or well-being. Titles and abstracts were independently assessed by two reviewers, with a third reviewer resolving disagreements. The initial search identified 291 articles, updated in December 2024. After screening, 285 articles were excluded for not meeting the inclusion criteria. Three studies met the criteria, focusing on interventions related to information dissemination, physical activity, and psychological support. These studies, conducted in the United States and Australia between 2015 and 2024, included randomized controlled trials with measured outcomes related to quality of life and/or well-being. The findings suggest that digital tools can improve the quality of life of AYACSs, particularly through peer interaction and personalized content. However, the limited number of studies and participants highlights the need for further research. The review also discusses challenges in involving AYACSs in digital programs and suggests optimizing digital tools by promoting peer links, integrating social networks, and considering self-determination theory.

Purpose Childhood, adolescent, and young adult cancer survivors represent a growing population with unique long-term follow-up (LTFU) needs, including managing late effects of treatment and ensuring psychosocial well-being. The e-QuoL project aims to develop digital tools tailored to enhance survivorship care. Method An online survey comprising 424 questions was distributed across 16 European countries. The distribution plan ensured engagement from diverse stakeholders, including patients, parents, and healthcare professionals. Descriptive and thematic analyses of survey data identified key content, functionalities, and features for the design of such tools. Results For participants (n = 53), the inclusion of a follow-up plan for the risk of sequelae in the first 5 years of follow-up was the highest priority (mean score, 9.62). Supportive care items were deemed important. In terms of functionalities, the most highly rated was the ability to send reminders to patients to not forget exams (mean score, 9.25). The inclusion of an algorithm to propose follow-up plans based on selected sections was also particularly valued (mean score, 9.10). Finally, the user experience of digital tools, including the need for these tools to be engaging, easy to use, and customizable, was highlighted by 66.7% of participants. Conclusion This study emphasizes the need for customizable, accessible, and user-centered digital tools to bridge disparities in LTFU care. Collaborative efforts to address technological, financial, and ethical barriers are essential to achieving equitable, effective survivorship support. Implications for Cancer Survivors By developing and implementing comprehensive digital tools, a more personalized, holistic, and effective model of survivorship care can be achieved.