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Cappellano A, Gorostegui M, Gonzalez-Ramella O, Filho NPC, Valencia D, Chantada L, Sampor C, Serrano MJ, Macedo C, Ramirez O, Sardinas S, Lezcano E, Calderón P, Gamboa Y, Fu L, Gómez W, Schelotto M, Ugaz C, Lobos P, Aguiar SDS, Moreno K, Palma J, Sánchez G, Moschella F, Gassant PYH, Velasquez T, Quintero K, Moreno F, Villarroel M, Fuentes Alabi S, Vasquez L, Challinor J, Chantada GL. International Society of Paediatric Oncology (SIOP) Global Mapping Programme: Latin American Society of Pediatric Oncology (SLAOP) country-level report. Pediatr Blood Cancer 2024; 71:e30973. [PMID: 38556746 DOI: 10.1002/pbc.30973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 02/27/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Latin American countries are improving childhood cancer care, showing strong commitment to implement the Global Initiative for Childhood Cancer, but there are scant publications of the situation at a continental level. METHODS As part of the International Society of Paediatric Oncology Global Mapping project, delegates of each country participating in the Latin American Society of Pediatric Oncology (SLAOP) and chairs of national pediatric oncology societies and cooperative groups were invited to provide information regarding availability of national pediatric cancer control programs (NPCCP), pediatric oncology laws, pediatric oncology tumor registries, and training programs and support to diagnosis and treatment. RESULTS Nineteen of the 20 countries participating in SLAOP responded. National delegates reported nine countries with NPCCP and four of them were launched in the past 5 years. National pediatric tumor registries are available in eight countries, and three provided published survival results. Fellowship programs for training pediatric oncologists are available in 12 countries. National delegates reported that eight countries provide support to most essential diagnosis and treatments and 11 provide partial or minimal support that is supplemented by civil society organizations. Seven countries have a pediatric oncology law. There are three international cooperative groups and four national societies for pediatric oncology. CONCLUSION Despite many challenges, there were dramatic advances in survivorship, access to treatment, and availability of NPCCP in Latin America. Countries with highest social development scores in general provide more complete support and are more likely to have NPCCP, training programs, and reported survival results.
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Affiliation(s)
| | - Maite Gorostegui
- Hospital Sant Joan de Déu, Pediatric Cancer Center Barcelona (PCCB), Barcelona, Spain
| | | | | | - Diana Valencia
- Department of Pediatric Oncology, IMAT Oncomedica AUNA, Monteria, Hospital Universitario de Santander, Bucaramanga, Colombia
| | | | | | | | - Carla Macedo
- Institute of Pediatric Oncology (IOP/GRAACC), São Paulo, Brazil
| | | | - Susan Sardinas
- Hospital del Niño Dr Ovidio Aliaga Uria, La Paz, Bolivia
| | - Eva Lezcano
- Hospital Central Del Instituto de Previsión Social (IPS), Asunción, Paraguay
| | | | - Yessika Gamboa
- Oncology Unit, National Children's Hospital, San José, Costa Rica
| | - Ligia Fu
- Hospital Escuela, Tegucigalpa, Honduras
| | - Wendy Gómez
- National Cancer Institute-INCART, Santo Domingo, Dominican Republic
| | | | - Cecilia Ugaz
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | | | | | | | - Julia Palma
- Hospital Dr Luis Calvo Mackenna, Santiago, Chile
| | | | - Filomena Moschella
- Hospital Universitario Dr Luis Razetti, Barcelona Edo Anzoategui, Barcelona, Venezuela
| | | | - Thelma Velasquez
- Unidad Nacional de Oncologia Pediátrica (UNOP), Guatemala City, Guatemala
| | - Karina Quintero
- Children's Hospital Dr Jose Renan Esquivel, Panama City, Panama
| | | | | | - Soad Fuentes Alabi
- Hospital Nacional de Ninos Benjamin Bloom y Centro Medico Ayudame a Vivir, San Salvador, El Salvador
| | - Liliana Vasquez
- Department of Noncommunicable Diseases and Mental Health, Unit of Noncommunicable Diseases, Pan American Health Organization/World Health Organization, Washington, District of Columbia, USA
| | - Julia Challinor
- University of California San Francisco, San Francisco, California, USA
| | - Guillermo L Chantada
- Hospital Sant Joan de Déu, Pediatric Cancer Center Barcelona (PCCB), Barcelona, Spain
- Hospital Pereira Rosell Fundación Perez-Scremini, Montevideo, Uruguay
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2
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Correa BT, Silva GSS, Mendes WJS, Maia ADM, Aleluia ACM, Fonseca TCC, da Guarda CC, Gonçalves MDS, Aleluia MM. Association of the clinical profile and overall survival of pediatric patients with acute lymphoblastic leukemia. Front Pediatr 2023; 11:1223889. [PMID: 37744444 PMCID: PMC10513176 DOI: 10.3389/fped.2023.1223889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction The clarification of etiopathology, the improvement of chemotherapy regimens and their risk stratifications, and the improvement in treatment support have increased the survival of children and adolescents affected by Acute Lymphoblastic Leukemia (ALL) past few years. This study aimed to estimate overall survival (OS) and event-free survival (EFS) in an onco-hematology treatment center in Brazil, reports the main clinical-laboratory characteristics of patients at diagnosis, verify the frequency of treatment-related adverse effects and the main causes of death. Material and methods Retrospective analysis involving patients diagnosed with ALL, treated with the protocol of the Brazilian Group for Treatment of Leukemias in Childhood (GBTLI), between 2010 and 2020 was carried out; the outcomes (relapse, deaths, development of new neoplasms) were analyzed SPSS® software was used for the statistical analyses, and the p-value was considered significant when less than 0.05 for all analyses. Results 109 patients were included in the study; the median age was 5 years, with a slight predominance of males. Sixty-six patients were classified as high-risk (HR) group and 43 patients were classified as low-risk (LR) group. After 5 years of diagnosis, the OS was 71.5%, and the EFS was 65%. No statistical difference was found between the HR and LR groups for OS and EFS, while leukocyte counts were statistically associated with the outcome of death (p = 0.028). Among the patients, 28 (25.6%) died due to infection accounting 46.4% of death causes. Among the 34 patients with unfavorable outcomes (death and/or relapse), 32 had no research for the minimal residual disease at the end of remission induction, and 25 were not investigated for the presence of chromosomal abnormalities. The most reported complications and treatment-related adverse effects were increased liver transaminases (85.9%), airway infection (79.4%), oral mucositis (67.2%), febrile neutropenia (64.4%), and diarrhea (36.4%). Conclusions The rates of OS and EFS obtained in this cohort are similar to those obtained in the few previous similar studies in Brazil and lower than those carried out in developed countries. The unavailability of prognostic tests may have hindered risk stratification and influenced the results obtained.
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Affiliation(s)
- Bruno Terra Correa
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
| | - Gabriela Sales Serra Silva
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
| | - Webert Joaquim Silva Mendes
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
| | | | - Augusto Cezar Magalhães Aleluia
- Departamento de Ciências Naturais, Universidade Estadual do Sudoeste da Bahia-Campus de Vitória da Conquista, Vitória da Conquista, Bahia, Brasil
| | | | - Caroline Conceição da Guarda
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
| | - Marilda de Souza Gonçalves
- Laboratório de Investigação Genética e Hematologia Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brasil
| | - Milena Magalhães Aleluia
- Departamento de Ciências Biológicas, Laboratório de Patologia Aplicada e Genética, Universidade Estadual de Santa Cruz, Ilhéus, Bahia, Brasil
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3
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Bokun J, Popović-Vuković M, Stanić D, Grujičić D, Pekmezović T, Janić D, Paripović L, Ilić V, Pudrlja Slović M, Sarić M, Mišković I, Nidžović B, Gavrilović N, Milinčić M, Nikitović M. Clinical Profile and Outcome of 806 Pediatric Oncology Patients Treated With Radiotherapy at the Serbian National Cancer Center. J Pediatr Hematol Oncol 2023; 45:116-122. [PMID: 36730662 DOI: 10.1097/mph.0000000000002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Abstract
Radiotherapy plays an important role in the multimodal treatment of childhood cancer. Our objective was to provide an analysis of pediatric oncology patients treated with radiotherapy in a national referral institution in Serbia. A retrospective chart review of children treated with radiotherapy between January 2007 and July 2018 was conducted. Of the 806 patients who were identified, 767 formed the basis of this study. CNS tumors (31.2%) were the most common tumors followed by leukemias (17.3%) and bone tumors (14.3%). The most common indication for radiotherapy was in adjuvant setting (69.1%). Anesthesia or sedation was performed on 115 patients. The 5-year and 10-year overall survival rates were 65.7% and 62.1%, respectively. A significant difference in survival in relation to tumor type was seen. The best survival rates were obtained in patients with retinoblastoma, followed by lymphomas and nephroblastoma, while patients with bone sarcomas had the worst survival. The intent of radiotherapy treatment was also a parameter associated with survival. Patients treated with palliative and definitive intent lived shorter than patients treated with prophylactic and adjuvant intent. Our study showed that good treatment outcomes can be achieved in specialized centers with an experienced team of professionals who are dedicated to pediatric oncology.
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Affiliation(s)
- Jelena Bokun
- University of Belgrade
- Pediatric Radiation Oncology Department
| | | | - Dragana Stanić
- University of Belgrade
- Pediatric Radiation Oncology Department
| | - Danica Grujičić
- University of Belgrade
- Pediatric Oncology Department
- Neuro-Oncology Department, Clinic of Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Tatjana Pekmezović
- University of Belgrade
- Institute of Epidemiology, University of Belgrade, Faculty of Medicine
| | | | | | | | | | - Milan Sarić
- Department of Medical Physics, Institute of Oncology and Radiology of Serbia
| | - Ivana Mišković
- Department of Medical Physics, Institute of Oncology and Radiology of Serbia
| | - Borko Nidžović
- Department of Medical Physics, Institute of Oncology and Radiology of Serbia
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Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, Nallasamy V, John A, Narasimhan S, Roselind FS. Cancer Statistics, 2020: Report From National Cancer Registry Programme, India. JCO Glob Oncol 2021; 6:1063-1075. [PMID: 32673076 PMCID: PMC7392737 DOI: 10.1200/go.20.00122] [Citation(s) in RCA: 387] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The systematic collection of data on cancer is being performed by various population-based cancer registries (PBCRs) and hospital-based cancer registries (HBCRs) across India under the National Cancer Registry Programme–National Centre for Disease Informatics and Research of Indian Council of Medical Research since 1982. METHODS This study examined the cancer incidence, patterns, trends, projections, and mortality from 28 PBCRs and also the stage at presentation and type of treatment of patients with cancer from 58 HBCRs (N = 667,666) from the pooled analysis for the composite period 2012-2016. Time trends in cancer incidence rate were generated as annual percent change from 16 PBCRs (those with a minimum of 10 years of continuous good data available) using Joinpoint regression. RESULTS Aizawl district (269.4) and Papumpare district (219.8) had the highest age-adjusted incidence rates among males and females, respectively. The projected number of patients with cancer in India is 1,392,179 for the year 2020, and the common 5 leading sites are breast, lung, mouth, cervix uteri, and tongue. Trends in cancer incidence rate showed an increase in all sites of cancer in both sexes and were high in Kamrup urban (annual percent change, 3.8%; P < .05). The majority of the patients with cancer were diagnosed at the locally advanced stage for breast (57.0%), cervix uteri (60.0%), head and neck (66.6%), and stomach (50.8%) cancer, whereas in lung cancer, distant metastasis was predominant among males (44.0%) and females (47.6%). CONCLUSION This study provides a framework for assessing the status and trends of cancer in India. It shall guide appropriate support for action to strengthen efforts to improve cancer prevention and control to achieve the national noncommunicable disease targets and the sustainable development goals.
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Affiliation(s)
- Prashant Mathur
- National Centre for Disease Informatics and Research, Bengaluru, India
| | | | - Meesha Chaturvedi
- National Centre for Disease Informatics and Research, Bengaluru, India
| | - Priyanka Das
- National Centre for Disease Informatics and Research, Bengaluru, India
| | | | | | - Vinodh Nallasamy
- National Centre for Disease Informatics and Research, Bengaluru, India
| | - Anish John
- National Centre for Disease Informatics and Research, Bengaluru, India
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Fischer AN, Roecker R, Saba da Silva N, Cavalheiro S, Finlay JL, Cappellano A, Osorio DS. Validated quantitative needs assessment differences in the management of children with central nervous system cancer between Brazil, an upper middle-income country, and the United States of America, a high income country. Pediatr Blood Cancer 2021; 68:e28958. [PMID: 33760367 DOI: 10.1002/pbc.28958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 01/06/2021] [Accepted: 01/25/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pediatric cancer cure rates differ among high-income countries (HIC) and upper middle-income countries (UMIC). We have compared individual capacities of two major referral pediatric centers from a HIC and an UMIC caring for children with central nervous system (CNS) cancer. METHODS A quantitative needs assessment questionnaire and key informant interviews, distributed in March of 2017, were used to evaluate the treatment of children with CNS cancer at Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) children's cancer center in São Paulo, Brazil and Nationwide Children's Hospital (NCH) in Columbus, Ohio, United States of America (USA). RESULTS Both hospitals had 24-hour pediatric oncology, nursing and intensivist coverage. Supportive care available at both institutions included social workers, psychologists, child life specialists, and physical/occupational/speech therapists. Differences included two part-time neuroradiologists and one pathologist specializing in neuropathology at IOP/GRAACC/UNIFESP, whereas eight full-time neuroradiologists and two neuropathologists at NCH/OSU. There were four pediatric neurosurgeons on staff at each hospital; however, there were only 2 operative days per week at IOP/GRAACC/UNIFESP, compared with 7 days at NCH/OSU. Additionally, time to initiation of radiation therapy at IOP/GRAACC/UNIFESP extended 2-4 weeks compared with less than 1 week at NCH/OSU. CONCLUSIONS Center-specific differences in resources exist in highly specialized hospitals caring for children with CNS cancer in HIC and UMIC. This quantitative needs assessment may facilitate the development of targeted strategies for effective interventions to improve on the management of children with CNS cancers.
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Affiliation(s)
- Allison N Fischer
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Roberto Roecker
- Division of Pediatric Oncology/BMT, IOP/GRAACC/UNIFESP, São Paulo, Brazil
| | | | - Sergio Cavalheiro
- Division of Pediatric Oncology/BMT, IOP/GRAACC/UNIFESP, São Paulo, Brazil
| | - Jonathan L Finlay
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Andrea Cappellano
- Division of Pediatric Oncology/BMT, IOP/GRAACC/UNIFESP, São Paulo, Brazil
| | - Diana S Osorio
- Division of Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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6
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Michalowski MB, Cecconello DK, Lins MM, Carvalho MDPSS, Silva KADS, Cristofani L, Bonilha TA, Baglioli BF, Pianovski MAD, Kuczynski AP, Santiago P, Rechenmacher C, Alegretti AP, Rodrigues K, de Magalhães MR, Daudt LE. Influence of different asparaginase formulations in the prognosis of children with acute lymphocytic leukaemia in Brazil: a multicentre, retrospective controlled study. Br J Haematol 2021; 194:168-173. [PMID: 33993488 DOI: 10.1111/bjh.17494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/27/2021] [Indexed: 01/22/2023]
Abstract
Our group recently showed that the (ASNase) formulation available in Brazil from 2017 to 2018 when used at the same dose and frequency as the formulation provided previously did not reach the activity considered therapeutic. Based on these, our goal was to assess the impact of these facts on the prognosis of children with ALL at different oncology centers. A multicentre retrospective observational study followed by a prospective follow-up. Patients aged >1 and <18 years in first-line treatment followed up at 10 referral centres, between 2014 and 2018 who received the formulation Leuginase® were identified (Group B). For each patient, the centre registered 2 patients who received ASNase in the presentation of Aginasa® exclusively (Group A). Data collection was registered using (Redcap® ). A total of 419 patients were included; 282 in Group A and 137 in B. Group A had a 3-year OS and EFS of 91·8% and 84·8% respectively, while Group B had a 3-year OS of 83·8% (P = 0·003) and EFS of 76·1% (P = 0·008). There was an impact on 3-year OS and EFS of children who received a formulation. This result highlights the importance of evaluating ASNase and monitoring its activity.
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Affiliation(s)
- Mariana Bohns Michalowski
- Translational Pediatrics Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Daiane Keller Cecconello
- Translational Pediatrics Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | | | | | | | - Thais Alcantra Bonilha
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | - Ciliana Rechenmacher
- Translational Pediatrics Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Karla Rodrigues
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Liane Esteves Daudt
- Translational Pediatrics Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.,Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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7
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Orjuela-Grimm M, Carreño SB, Liu X, Ruiz A, Medina P, Ramirez Ortiz MA, Rendon JR, Molina NCL, Pinilla H, Hinojosa D, Rodriguez L, Connor AO, Rodriguez FM, Castañeda MVP, Cabrera-Muñoz L. Sunlight exposure in infancy decreases risk of sporadic retinoblastoma, extent of intraocular disease. Cancer Rep (Hoboken) 2021; 4:e1409. [PMID: 33960746 PMCID: PMC8714544 DOI: 10.1002/cnr2.1409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 12/28/2022] Open
Abstract
Background Prior ecologic studies suggest that UV exposure through sunlight to the retina might contribute to increased retinoblastoma incidence. Aims Our study objectives were (1) to examine the relationship between exposure to sunlight during postnatal retinal development (prior to diagnosis of sporadic disease) and the risk of retinoblastoma, and (2) to examine the relationship between sun exposure during postnatal retinal development, and the extent of disease among children with unilateral and bilateral retinoblastoma. Methods and results We interviewed 511 mothers in the EpiRbMx case‐control study about their child's exposure to sunlight during postnatal retinal cell division by examining three time periods prior to Rtb diagnosis coinciding with developmental stages in which outdoor activities vary. Weekly sun exposure was compared by age period, between unilateral (n = 259), bilateral (n = 120), and control (n = 132) children, accounting for two factors affecting UV exposure: residential elevation and reported use of coverings to shield eyes. For cases, association between sunlight exposure and clinical stage was examined by laterality at each age period. After adjusting for maternal education and elevation, sun exposure was lower in cases than controls in all three age periods especially during the first 6 months, and in children 12–23 months whose mothers did not cover their eyes when outdoors. In children diagnosed after 12 months of age, sun exposure during the second year of life (age 12–23 months) appeared inversely correlated (r = −0.25) with more advanced intraocular disease in bilateral Rtb children after adjusting for maternal education, residential elevation, and age of diagnosis (p < .09) consistent with effects of Vitamin D exposure on intraocular spread in earlier transgenic murine models of retinoblastoma, and suggesting potential chemopreventive strategies. Conclusion Sun exposure in early childhood is protective for retinoblastoma and may decrease degree of intraocular spread in children with bilateral Rtb.
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Affiliation(s)
- Manuela Orjuela-Grimm
- Mailman School of Public Health, Department of Epidemiology, Columbia University Medical Center, New York, New York, USA.,Department of Pediatrics (Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation), Columbia University Medical Center, New York, New York, USA
| | - Silvia Bhatt Carreño
- Mailman School of Public Health, Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Xinhua Liu
- Mailman School of Public Health, Department of Biostatistics, Columbia University Medical Center, New York, New York, USA
| | - Ambar Ruiz
- Mailman School of Public Health, Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Paola Medina
- Mailman School of Public Health, Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Marco A Ramirez Ortiz
- Department of Ophthalmology, Hospital Infantil de Mexico, Federico Gomez, Mexico City, Mexico
| | - Josefina Romero Rendon
- Centro Medico Nacional Siglo XXI, Instituto Mexicano de Seguro Social, Hospital de Pediatria, Mexico City, Mexico
| | | | - Hector Pinilla
- Mailman School of Public Health, Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Daniela Hinojosa
- Mailman School of Public Health, Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Laura Rodriguez
- Mailman School of Public Health, Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Anita O' Connor
- Mailman School of Public Health, Department of Environmental Health Science, Columbia University Medical Center, New York, New York, USA
| | - Fabiola Mejia Rodriguez
- Centro de Investigacion de Nutricion y Salud, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - M Veronica Ponce Castañeda
- Centro Medico Nacional Siglo XXI, Instituto Mexicano de Seguro Social, Hospital de Pediatria, Mexico City, Mexico
| | - Lourdes Cabrera-Muñoz
- Department of Pathology, Hospital Infantil de Mexico, Federico Gomez, Mexico City, Mexico
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8
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Arancibia AM, De Farias CB, Brunetto AL, Roesler R, Gregianin LJ. The effect of hospital care volume on overall survival of children with cancer in Southern Brazil. Pediatr Blood Cancer 2021; 68:e28779. [PMID: 33118699 DOI: 10.1002/pbc.28779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study was to analyze the effect of hospital care volume on the overall survival of children with cancer in Southern Brazil. PATIENTS AND METHODS We performed a retrospective cohort study of 1378 cancer patients aged 0-19 years, diagnosed with cancer between August 1, 2009 and December 31, 2015 in Rio Grande do Sul, who received hospital treatment in institutions affiliated with the Universal Health Care System (Sistema Único de Saúde [SUS]). RESULTS Most children and adolescents were male (56.9%) and White (75.8%). The most common types of cancer in our cohort were acute leukemia (40.7%), followed by lymphoma (15.9%) and central nervous system tumors (8.8%). Ninety-five percent of the patients were treated in specialized pediatric oncology centers. The cumulative probability of survival at 5 years for all patients was 73.8% (95% confidence interval [CI] 71.4-76.0%). Survival was significantly higher for patients younger than 4 years of age (P = .012) compared to all other age groups. Patients treated in institutions with a pediatric oncology patient volume of less than 15 patients/year were 41% more likely to die than patients treated in institutions with a volume of 60 patients/year or more (P = .029). CONCLUSION Cancer is the leading cause of death by natural causes in all age groups in Brazil, but, even so, childhood tumors are rare. This complexity makes childhood cancer care a challenge. In this study, we reiterate that pediatric cancer patients demonstrate better overall survival when treated in high-volume hospitals.
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Affiliation(s)
- Alejandro Mauricio Arancibia
- Graduate Program in Medical Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Caroline Brunetto De Farias
- Children's Cancer Institute, Porto Alegre, Brazil.,Department of Pharmacology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Cancer and Neurobiology Laboratory, Experimental Research Center, Clinical Hospital (CPE-HCPA), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Rafael Roesler
- Graduate Program in Medical Sciences, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Pharmacology, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Cancer and Neurobiology Laboratory, Experimental Research Center, Clinical Hospital (CPE-HCPA), Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lauro José Gregianin
- Department of Pediatrics, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Children's Cancer Institute, Porto Alegre, Brazil
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9
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Kabre RS, Kamble KM. Retinoblastoma: A retrospective analysis of 141 patients from 1983 to 2013 at a tertiary care hospital in Nagpur, India. South Asian J Cancer 2020; 8:195-197. [PMID: 31489299 PMCID: PMC6699240 DOI: 10.4103/sajc.sajc_314_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: There is scarcity of data regarding clinical presentation and outcome of retinoblastoma patients in India. Objectives: The objective of this study was to assess the clinical profile of retinoblastoma patients in a tertiary care hospital in India from 1983 to 2013. Subjects and Methods: A retrospective analysis of clinical records of 141 patients with retinoblastoma registered from 1983 to 2013 at Government Medical College, Nagpur, India, was conducted. Demographics, clinical features, modes of treatment, and outcome of the patients were assessed. Results: Majority of patients (81 [57.45%]) presented in the age group of 1–3 years and were males. One hundred and fourteen patients (80.85%) had unilateral disease, while rare presentations of trilateral/quadrilateral retinoblastoma were also noted. Proptosis was seen in 81 (57.45%) patients as presenting symptom. Eighty-nine patients (63.12%) had locally invasive disease-involving sites. Forty-four patients (31.19%) developed distant metastasis. Surgical management and external beam radiotherapy were followed in majority of patients. Trend of increased usage of chemotherapy was seen from the mid-1990s. One hundred and twelve patients (79.43%) died with the disease. Conclusions: Data from this study show late diagnosis, leading to poor outcome for patients with advanced retinoblastoma, which is in accordance with data from other developing countries. Even though management of patients changed in accordance with changing standard of care over the decade, mortality remained high.
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Affiliation(s)
- Rohit S Kabre
- Department of Radiation Oncology, P.D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - Krishna M Kamble
- Department of Radiation Therapy and Oncology, Government Medical College and Hospital, Nagpur, Maharashtra, India
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10
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de Oliveira MM, E Silva DRM, Ramos FR, Curado MP. Children and adolescents cancer incidence, mortality and survival a population-based study in Midwest of Brazil. Cancer Epidemiol 2020; 68:101795. [PMID: 32818795 DOI: 10.1016/j.canep.2020.101795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify time trends in incidence, mortality and 5-year relative survival in children and adolescents with cancer in Goiania-Goias, Brazil, during the years of 1996-2012. METHODS Incidence and mortality age-standardized rates (ASR) were calculated, and trends were identified by determining the Average Annual Percentage Change (AAPC). Five-year relative survival were estimated. RESULTS The overall incidence ASR (1996-2012) was 164.2/1,000,000 in both genders. In boys was 176.6/1,000,000, in girls it was 151.8/1,000,000. Overall mortality ASR for both gender were 69.3/1,000,000. Incidence rates (AAPC: -0.5; 95 %CI: -2.4;1.4) and mortality rates (AAPC: 0.0; 95 %CI: -2.6;2;7) were stable in the period. Five-year relative survival for all cancers were 63.9 %, with the highest survival rates for retinobastoma (83.5 %), germ cell tumors (79.8 %), and lymphomas (72.7 %). It was observed an increase in survival in the period from de 62.8 % (1996 a 2003) to 65.0 % from 2004 to 2012. CONCLUSIONS Children and adolescent cancer incidence and mortality rates were higher in Goiania, but both are stable overall. The relative survival slighly improved in the period but remained lower mainly for leukemias.
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Affiliation(s)
- Max Moura de Oliveira
- Group of Epidemiology and Statistics on Cancer, International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil
| | | | | | - Maria Paula Curado
- Group of Epidemiology and Statistics on Cancer, International Research Center, A.C. Camargo Cancer Center, São Paulo, Brazil.
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11
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Prophylactic photobiomodulation therapy using 660 nm diode laser for oral mucositis in paediatric patients under chemotherapy: 5-year experience from a Brazilian referral service. Lasers Med Sci 2020; 35:1857-1866. [PMID: 32535807 DOI: 10.1007/s10103-020-03060-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/01/2020] [Indexed: 12/22/2022]
Abstract
The use of photobiomodulation therapy (PBMT) in the prevention of oral mucositis (OM) in paediatric care has increased. In this article, we report data of paediatric oncology/haematopoietic stem cell transplantation (HSCT) patients treated with PBMT to prevent chemotherapy-induced OM. A retrospective study was conducted at a Brazilian referral service. Prophylactic PBMT was used in children and adolescents (≤ 17 years) following the protocol: InGaAIP, 660 nm, 100 mW, 2 J, 3.33 W/cm2, and 20 s per point. Demographic data and OM severity scores were assessed. A regression model tested the association between OM with prophylactic PBMT and antineoplastic therapy. A total of 148 individuals who had undergone 358 chemotherapy cycles were analysed. A higher occurrence of OM was observed in HSCT and osteosarcoma (OS) patients. Except for HSCT, OM was associated with methotrexate (MTX) use in all disease groups. PBMT significantly reduced OM severity in acute lymphoblastic leukaemia (ALL) and OS patients. OM grade was 3.16 and 5.45 times higher among individuals with ALL and OS, who had not undergone prophylactic PBMT compared with those who had undergone prophylactic PBMT (p < 0.001). PBMT prevented chemotherapy-induced OM. Individuals who used MTX and did not undergo prophylactic PBMT were at increased risk of OM.
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12
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Arboleda LPA, Hoffmann IL, Cardinalli IA, Gallagher KPD, Santos-Silva AR, Mendonça RMHD. Oral and maxillofacial cancer in pediatric patients: 30 years experience from a Brazilian reference center. Int J Pediatr Otorhinolaryngol 2020; 131:109879. [PMID: 31951980 DOI: 10.1016/j.ijporl.2020.109879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/06/2019] [Accepted: 01/08/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of this study is to determine the relative frequency, demographic distribution and clinicopathological features of pediatric oral and maxillofacial cancer (POMC). METHODS Medical records were retrospectively reviewed for all cancer cases diagnosed from 1986 to 2016 affecting patients aged 19 years and younger. Demographic variables, anatomical site, and histopathological diagnoses were collected and analyzed by descriptive statistics. RESULTS Fifty-five (0.77%) POMCs were found among 7181 pediatric malignancies. Mean age at diagnosis was 8 years and patients aged 5-9 years presented the higher prevalence of malignant tumors (40%). White male patients were more frequently affected (78.18% and 65.45%, respectively). The most common cancer type was lymphomas (52.73%) followed by sarcomas (27.27%) and carcinomas (20%). Burkitt lymphoma (32.73%), rhabdomyosarcoma (14.55%), diffuse large B-cell lymphoma (9.09%), and mucoepidermoid carcinoma (9.09%) were the most common histopathological diagnoses. The main affected anatomical site was the oropharynx (38.18%), followed by salivary glands (30.91%), maxillofacial bone (20%), and oral cavity (10.91%). CONCLUSION POMC has a low incidence; however, highly aggressive tumors, such as lymphomas and sarcomas, are common in this scenario. A better knowledge about the clinicopathological distribution of POMC may contribute to early diagnosis and improve survival rates.
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Affiliation(s)
| | | | | | | | | | - Regina Maria Holanda de Mendonça
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Brazil; Boldrini Children's Center, Campinas, Brazil
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13
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Rae C, Shah N, De Pauw S, Costa A, Barr RD. System Performance Indicators for Adolescent and Young Adult Cancer Care and Control: A Scoping Review. J Adolesc Young Adult Oncol 2020; 9:1-11. [DOI: 10.1089/jayao.2019.0069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlene Rae
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Nishwa Shah
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonja De Pauw
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Costa
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ronald D. Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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14
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Kesarapu S, Vangala N, Uppin SG, Uppin MS, Paul TR, Rajasekhar L. Acute Leukemia Presenting with Musculoskeletal Manifestations: A Case Series. Indian J Med Paediatr Oncol 2020. [DOI: 10.4103/ijmpo.ijmpo_113_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Introduction: Leukemia is the most common childhood malignancy accounting for 30%–40% of cases. Acute lymphoblastic leukemia is the most common leukemia in children with peak incidence in 2–6 years of age. The present study aims to assess the incidence of acute leukemia in patients presenting with musculoskeletal manifestations. Materials and Methods: This is a retrospective study conducted in a tertiary center from January 2014 to December 2018. A total of 63 children presented with musculoskeletal manifestations and underwent bone marrow examination. Based on final marrow diagnosis, the study group was divided into leukemic and nonleukemic groups. Results: Fever was the most common presenting complaint and was present in all the patients of both the groups. The occurrence of hepatosplenomegaly was comparatively higher in the leukemic group than in patients with juvenile idiopathic arthritis (JIA). The predominant type of arthritis was oligoarticular (68.15%) in the leukemic group and polyarticular (77.27%) in the nonleukemic group. Rheumatoid rash was noted in 20% of JIA patients, and none of the patients in the leukemic group had rash. The percentages of anemia, leukopenia, and thrombocytopenia were statistically higher in leukemia patients than in JIA patients. Conclusion: Bone marrow studies are a prerequisite in diagnosing leukemias. However, based on the presence of few atypical clinical and laboratory features, leukemia can be excluded in JIA patients.
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Affiliation(s)
- Swetha Kesarapu
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Navatha Vangala
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shantveer G Uppin
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Tara Roshni Paul
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Liza Rajasekhar
- Department of Rheumatology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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15
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Silva-Junior AL, Alves FS, Kerr MWA, Xabregas LA, Gama FM, Rodrigues MGA, Torres AS, Tarragô AM, Sampaio VS, Carvalho MPSS, Fraiji NA, Malheiro A, Costa AG. Acute lymphoid and myeloid leukemia in a Brazilian Amazon population: Epidemiology and predictors of comorbidity and deaths. PLoS One 2019; 14:e0221518. [PMID: 31437246 PMCID: PMC6705820 DOI: 10.1371/journal.pone.0221518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/08/2019] [Indexed: 01/07/2023] Open
Abstract
Introduction Leukemia is the most common cancer in children and has the highest rates of incidence in industrialized countries, followed by developing countries. This epidemiologic profile can mainly be attributed to the availability of diagnostic resources. In Brazil, leukemia diagnosis is a challenge due to financial viability, lack of hemovigilance services in isolated regions and the vast size of the territory. Its incidence in the state of Amazonas has been increasing since 2010. Therefore, this study aims to describe the epidemiological pattern and spatial distribution of patients with acute lymphoid leukemia and acute myeloid leukemia in Amazonas and identify the predictors of comorbidity and death. Materials and methods A retrospective cross-sectional study was carried out based on patients’ data which was obtained from the database of a referral center for the period of 2005 to 2015. Variables included age, gender, ethnicity, civil status, schooling, income, location of residence, subtype of leukemia, comorbidities, and date of death. The spatial distribution was performed using QGIS v.2.18. Stata software was used for univariable and multivariable logistic regression to evaluate the association between both comorbidities and death for all characteristic groups of ALL and AML. Results The group that was studied was composed of 577 ALL and 266 AML patients. For both, most patients were male, with a schooling period of 1–4 years, received<1 minimum wage, and lived mostly in Manaus, followed by the municipality of Tefé. There was no association between the development of comorbidities and analyzed variables in patients with ALL. AML patients that were >60 years old and with family history of the disease had the highest risk of developing comorbidities (OR = 5.06, p = 0.038; OR = 2.44, p = 0.041, respectively). Furthermore, patients with ALL and in the 41-50-year age group had a higher risk of death (OR = 31.12; p = 0.001). No association between death and explanatory variables were found in patients with AML. In addition, significant difference was observed in time to death (chi2 = 4,098.32, p = 0.000), with 50% of patients with AML dying within two years after diagnosis, whereas in ALL, this percentual of death only is reached in approximately 5 years. Conclusion Our study describes the data of patients with acute leukemia in Amazonas, a remote region in the north of Brazil. In addition, it highlights the importance of hemovigilance in an Amazon region state, while focusing on peripheral areas which don't have prevention, diagnosis and treatment tools for this disease.
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Affiliation(s)
- Alexander Leonardo Silva-Junior
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Fabíola Silva Alves
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Marlon Wendell Athaydes Kerr
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Lilyane Amorim Xabregas
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Fábio Magalhães Gama
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Maria Gabriela Almeida Rodrigues
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | - Alexandre Santos Torres
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
| | - Andréa Monteiro Tarragô
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Vanderson Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Fundação de Vigilância em Saúde do Amazonas, Manaus, Brazil
| | - Maria Perpétuo Socorro Sampaio Carvalho
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Nelson Abrahim Fraiji
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
| | - Adriana Malheiro
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
| | - Allyson Guimarães Costa
- Diretoria de Ensino e Pesquisa, Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Ciências Aplicadas a Hematologia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Programa de Pós-Graduação em Imunologia Básica e Aplicada, Instituto de Ciências Biológicas, Universidade Federal do Amazonas (UFAM), Manaus, AM, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
- Instituto de Pesquisa Clínica Carlos Borborema, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- * E-mail:
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Bawazir A, Al-Zamel N, Amen A, Akiel MA, Alhawiti NM, Alshehri A. The burden of leukemia in the Kingdom of Saudi Arabia: 15 years period (1999-2013). BMC Cancer 2019; 19:703. [PMID: 31315607 PMCID: PMC6637507 DOI: 10.1186/s12885-019-5897-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/01/2019] [Indexed: 12/29/2022] Open
Abstract
Background Leukemia is a malignant neoplasm that arises from hematopoietic cells. The number of leukemia cases has dramatically increased from 297,000 to 437, 033 cases worldwide. As result, the the Saudi Cancer Registry ramked leukemia as the 5th type of cancer cases among both genders in Saudi Arabia. Data on the trend and incidence of leukemnia in Saudi Arabia is lacking. This study aims to report the trend and incidence of leukemia in Saudi Arabia using available data from the Saudi Cancer Registry (SCR), as a population-based cancer registry in the country over a period of 15 years (1999–2013). Methods Data of registered leukemia cases between years 1999–2013 were retrieved from the Saudi Council of Health, Saudi Cancer Registry. Data were coded using the International Classification of Diseases for Oncology (ICD-O). Main and essential variables were retrieved such as age, sex, years of incidence, residency, and histopathological type of leukemia. Results A total of 8712 cases of leukemia were analyzed in this study, 57.2% were males and 42.8% were females. Around 33.6% of cases were from the central region of Saudi Arabia. The most diagnosed type of leukemia was the Precursor B-cell lymphoblastic leukemia (18.7%), followed by Precursor cell lymphoblastic leukemia, NOS (17.3%) with equal percentage of reported cases between males and females in these subsets. Conclusion Ove a period of 15 years, the trend of leukemia showed the likelihood of increase in rate particularly in males with highest incidence reported from the central region of Saudi Arabia which needs more investigation. Resources for diagnosis and treatment should be planned with more orientation toward the accurate diagnosis of leukemia to minimize the number of “none specific diagnosis”.
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Affiliation(s)
- Amen Bawazir
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia.
| | - Nouf Al-Zamel
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abeer Amen
- College of Dentistry, Aden University, Aden, Yemen
| | - Maaged A Akiel
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Naif M Alhawiti
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
| | - Ali Alshehri
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Ribeiro ILA, de Andrade Lima Neto E, Valença AMG. Chemotherapy in Pediatric Oncology Patients and the Occurrence of Oral Mucositis. Int J Clin Pediatr Dent 2019; 12:261-267. [PMID: 31866707 PMCID: PMC6898864 DOI: 10.5005/jp-journals-10005-1633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is known that chemotherapeutic agents are not equally stomatotoxic and oral cavity lesions are the most frequent complications encountered in antineoplastic chemotherapy. AIMS The objective of this study was to evaluate the occurrence of severe oral mucositis during a chemotherapy treatment and to identify its relationship with the chemotherapeutic class used. MATERIALS AND METHODS This is a longitudinal, prospective, and observational study that used an intensive direct observation technique for assessing the oral clinical conditions and the chemotherapy treatment administered to 105 patients (both children and adolescents). RESULTS Severe oral mucositis occurred in all the 10 weeks of evaluation (ranging from 16.2 to 31.4%) and the association between the type of chemotherapy and the occurrence of severe oral mucositis is recorded only in the 6th week, with the chance to develop severe oral mucositis being 3.07 (3.85-2.29) times higher in patients underwent chemotherapy with antimetabolites than in those who have not used chemotherapy (p = 0.012). CONCLUSION It was concluded that the chemotherapeutic agents most related to severe oral mucositis and to the interruption in chemotherapy are those of the class of antimetabolites, especially the methotrexate and the Ara C. HOW TO CITE THIS ARTICLE Ribeiro ILA, de Andrade Lima Neto E, et al. Chemotherapy in Pediatric Oncology Patients and the Occurrence of Oral Mucositis. Int J Clin Pediatr Dent 2019;12(4):261-267.
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Affiliation(s)
- Isabella LA Ribeiro
- Department of Clinical and Social Dentistry, Postgraduate Program in Dentistry, Federal University of Paraíba, Brazil
| | | | - Ana MG Valença
- Department of Clinical and Social Dentistry, Federal University of Paraíba, Brazil
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Belgaumi AF, Pathan GQ, Siddiqui K, Ali AA, Al-Fawaz I, Al-Sweedan S, Ayas M, Al-Kofide AA. Incidence, clinical distribution, and patient characteristics of childhood cancer in Saudi Arabia: A population-based analysis. Pediatr Blood Cancer 2019; 66:e27684. [PMID: 30803142 DOI: 10.1002/pbc.27684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/08/2019] [Accepted: 02/06/2019] [Indexed: 11/09/2022]
Abstract
PURPOSE Information regarding the incidence and patterns of childhood malignancies is disproportionately overrepresented by high-income countries, representing mainly the Caucasian population. There is a need to evaluate and disseminate information for other ethnicities, particularly from the Middle East. METHODS Data from the National Cancer Registry, Saudi Arabia (SA-NCR), for pediatric patients (age 0-14 years) diagnosed between 2005 and 2009 and for similar patients at our institution during the same period were analyzed. Population numbers reported in the 2007 national census were used to calculate the annual incidence of childhood cancer. RESULTS Data from SA-NCR on 3885 patients were included in this analysis. The median age was 5.58 years, and 57.3% were males. The annual age-specific cancer incidence rate (ASR) for children in SA is 99.83 per million population; ASR per million for lymphoid leukemia is 25.75, 12.05 for brain tumors, and 9.82 for Hodgkin lymphoma. Of all childhood cancers in SA, 35% were treated at our institution. The five-year overall survival for these 1350 patients is 74.6% (median follow-up 7.52 years [95% confidence interval: 7.36-7.68]). Significant differences in the distribution of childhood malignancy subtypes were evident compared with other countries. CONCLUSION We have reported differences in the cancer ASR and cancer subtype distribution for children in SA as compared with the worldwide incidence and with other populations. This paper provides a comprehensive epidemiological overview of childhood cancer in SA, which could be extrapolated to other regional Arab populations.
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Affiliation(s)
- Asim F Belgaumi
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia.,Department of Oncology, Aga Khan University, Karachi, Pakistan
| | - Ghulam Q Pathan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia
| | - Afshan A Ali
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia
| | - Ibrahim Al-Fawaz
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia
| | - Suleimman Al-Sweedan
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia.,Jordan University of Science and Technology, Irbid, Jordan
| | - Mouhab Ayas
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia.,Al-Faisal University, Riyadh, Saudi Arabia
| | - Amani A Al-Kofide
- Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital and Research Center and the King Fahad National Center for Children's Cancer, Riyadh, Saudi Arabia.,Al-Faisal University, Riyadh, Saudi Arabia
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19
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Balmant NV, Reis RDS, Santos MDO, Maschietto M, de Camargo B. Incidence and mortality of bone cancer among children, adolescents and young adults of Brazil. Clinics (Sao Paulo) 2019; 74:e858. [PMID: 31090796 PMCID: PMC6536091 DOI: 10.6061/clinics/2019/e858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/17/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Bone cancers occur frequently in children, adolescents, and young adults aging 15 to 29 years. Osteosarcoma and Ewing sarcoma are the most frequent subtypes in this population. The aim of this study was to describe incidence and mortality trends of bone cancers among Brazilian children, adolescents and young adults. METHODS Incidence information was obtained from 23 population-based cancer registries. Mortality data were extracted from the Atlas of Cancer Mortality from 1979 to 2013. Specific and adjusted rates per million were analyzed according to gender, morphology and age at diagnosis. Median rates were used as a measure of central tendency. Joinpoint regression was applied to analyze trends. RESULTS Median incidence rates were 5.74 and 11.25 cases per million in children and young adults respectively. Osteosarcoma in the 15-19 years aged group had the highest incidence rates. Stable incidence rates were observed among five registries in 0-14 year's age group. Four registries had a decreased incidence trend among adolescents and young adults. Median mortality rates were 1.22 and 5.07 deaths per million in children and young adults respectively. Increased mortality was observed on the North and Northeast regions. Decreased mortality trends were seen in the South (children) and Southeast (adolescents and young adults). CONCLUSION Osteosarcoma and Ewing Sarcoma are the most incident bone cancers in all Brazilian regions. Bone cancers showed incidence and mortality patterns variation within the geographic regions and across age groups, although not significant. Despite limitations, it is crucial to monitor cancer epidemiology trends across geographic Brazilian regions.
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Affiliation(s)
- Nathalie Vieira Balmant
- Instituto Nacional do Cancer, Rio de Janeiro, RJ, BR
- Centro de Pesquisa, Instituto Nacional de Cancer, Rio de Janeiro, RJ, BR
| | | | | | - Mariana Maschietto
- Laboratorio Nacional de Biociencias, Centro Nacional de Pesquisa em Energia e Materiais, Campinas, SP, BR
| | - Beatriz de Camargo
- Centro de Pesquisa, Instituto Nacional de Cancer, Rio de Janeiro, RJ, BR
- Corresponding author. E-mail:
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Barbosa IM, Sales DS, Arregi MU, Rigotto RM. [Cancer among children and adolescents: relationship with the poles of agricultural irrigation in the state of Ceará, Brazil]. CIENCIA & SAUDE COLETIVA 2019; 24:1563-1570. [PMID: 31066857 DOI: 10.1590/1413-81232018244.06662017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/28/2017] [Indexed: 11/22/2022] Open
Abstract
The scope of this article is to assess the magnitude and the spatial and temporal trend of cancer in children and adolescents and its association with the agricultural irrigation poles in the State of Ceará from 2000 to 2012. This involves ecological research on morbidity and mortality indicators in the State Ceará between 2000 and 2012. The study population was made up of children and adolescents aged from 0 to 19 years diagnosed with cancer. Information was collected in the Hospital Cancer Register and in the Mortality Information System. A total of 3274 cases were treated in CACONs and UNACONs and 2,080 deaths due to neoplasms were identified. In the association of cancer cases with agricultural irrigation poles, it was detected that the highest concentrations of cases are in micro-regions that have irrigation poles. The microregions with the highest concentrations of child and adolescent cancer coincide with the agricultural irrigation poles.
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Affiliation(s)
- Isadora Marques Barbosa
- Departamento de Saúde Comunitária , Centro de Ciências da Saúde, Universidade Federal do Ceará. R. Alexandre Baraúna, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
| | | | | | - Raquel Maria Rigotto
- Departamento de Saúde Comunitária , Centro de Ciências da Saúde, Universidade Federal do Ceará. R. Alexandre Baraúna, Rodolfo Teófilo. 60430-160 Fortaleza CE Brasil.
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Factors Contributing to the Duration of Chemotherapy-Induced Severe Oral Mucositis in Oncopediatric Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061153. [PMID: 29865201 PMCID: PMC6025254 DOI: 10.3390/ijerph15061153] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 11/17/2022]
Abstract
This study analyzes the factors contributing to the duration of severe oral mucositis in oncopediatric patients. A longitudinal study was conducted in the pediatric department of a cancer referral hospital between 2013 and 2017. Seventy-three patients diagnosed with cancer undergoing chemotherapy protocols were analyzed. Oral evaluations were performed using the Modified Oral Assessment Guide criteria, and the data were collected from the patients’ records. The Kaplan-Meier method was used to estimate survival curves. Most patients were males (52.1%), of mixed race (“pardo”) (49.3%), with a mean age of 7.56 years (±5.34). There was a predominance of patients diagnosed with solid tumors (52.1%), with no metastasis (86.3%), using natural product chemotherapeutics (56.2%), who had not undergone a bone marrow transplant (97.3%); amputation was observed in 35.6% of patients, while death rates were as high as 8.2%. The survival analysis estimated a mean time of 30.6 days until complete remission of severe oral mucositis. The regression analysis showed that patients over 10 years old had a median mucositis duration 1.4 times greater than those at the age of 10 years or younger. Patients without metastasis had a median mucositis duration 1.7 times greater than those with metastasis (p-value ≤ 0.10). Increasing age and the absence of metastasis were conditions that prolonged the duration of severe oral mucositis.
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Arboleda LPA, Hoffmann IL, Cardinalli IA, Santos-Silva AR, de Mendonça RMH. Demographic and clinicopathologic distribution of head and neck malignant tumors in pediatric patients from a Brazilian population: A retrospective study. J Oral Pathol Med 2018; 47:696-705. [DOI: 10.1111/jop.12724] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 02/05/2023]
Affiliation(s)
| | | | | | - Alan Roger Santos-Silva
- Department of Oral Diagnosis; Piracicaba Dental School; University of Campinas; Piracicaba Brazil
| | - Regina Maria Holanda de Mendonça
- Department of Oral Diagnosis; Piracicaba Dental School; University of Campinas; Piracicaba Brazil
- Boldrini Children's Center; Campinas Brazil
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Georgakis MK, Dessypris N, Baka M, Moschovi M, Papadakis V, Polychronopoulou S, Kourti M, Hatzipantelis E, Stiakaki E, Dana H, Bouka E, Antunes L, Bastos J, Coza D, Demetriou A, Agius D, Eser S, Gheorghiu R, Sekerija M, Trojanowski M, Zagar T, Zborovskaya A, Ryzhov A, Tragiannidis A, Panagopoulou P, Steliarova-Foucher E, Petridou ET. Neuroblastoma among children in Southern and Eastern European cancer registries: Variations in incidence and temporal trends compared to US. Int J Cancer 2017; 142:1977-1985. [PMID: 29250786 DOI: 10.1002/ijc.31222] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/29/2017] [Accepted: 11/03/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Marios K. Georgakis
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
| | - Margarita Baka
- Department of Pediatric Hematology-Oncology; “Pan. & Agl. Kyriakou” Children's Hospital; Athens Greece
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics; University of Athens, “Agia Sofia” Children's Hospital; Athens Greece
| | - Vassilios Papadakis
- Department of Pediatric Hematology-Oncology; “Agia Sofia” Children's Hospital; Athens Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology-Oncology; “Agia Sofia” Children's Hospital; Athens Greece
| | - Maria Kourti
- Department of Pediatric Hematology and Oncology; Hippokration Hospital; Thessaloniki Greece
| | - Emmanuel Hatzipantelis
- 2nd Hematology Oncology Unit, 2nd Pediatric Department; Aristotle University of Thessaloniki, AHEPA Hospital; Thessaloniki Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology; University of Crete; Heraklion Greece
| | - Helen Dana
- Department of Pediatric Hematology-Oncology; “Mitera” Children's Hospital; Athens Greece
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
| | - Luis Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Institute of Oncology; Porto Portugal
| | - Joana Bastos
- Registo Oncológico Regional do Centro (ROR-Centro), Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E.; Coimbra Portugal
| | - Daniela Coza
- The Oncology Institute “Prof. Dr. Ion Chiricuţă”; Cluj-Napoca Romania
| | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health; Nicosia Cyprus
| | - Domenic Agius
- Department for Policy in Health - Health Information and Research; Malta National Cancer Registry; Pieta Malta
| | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir and Hacettepe; University Institute of Public Health; Ankara Turkey
| | - Raluca Gheorghiu
- Regional Cancer Registry, National Institute of Public Health; Iasi Romania
| | - Mario Sekerija
- Croatian Institute of Public Health, Croatian National Cancer Registry; Zagreb Croatia
- Andrija Štampar School of Public Health, School of Medicine; University of Zagreb; Zagreb Croatia
| | - Maciej Trojanowski
- Wielkopolskie Centrum Onkologii, Poznan University of Medical Sciences; Poznan Poland
| | - Tina Zagar
- Cancer Registry of Slovenia, Institute of Oncology Ljubljana; Ljubljana Slovenia
| | - Anna Zborovskaya
- Belarusian Research Center for Paediatric Oncology, Haematology and Immunology; Childhood Cancer Subregistry of Belarus; Minsk Belarus
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Institute of Cancer; Kiev Ukraine
| | - Athanassios Tragiannidis
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
- 2nd Hematology Oncology Unit, 2nd Pediatric Department; Aristotle University of Thessaloniki, AHEPA Hospital; Thessaloniki Greece
| | - Paraskevi Panagopoulou
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
- Fourth Department of Pediatrics; Medical School, General Hospital “Papageorgiou”, Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Eleni Th. Petridou
- Department of Hygiene, Epidemiology and Medical Statistics Medical School; National and Kapodistrian University of Athens; Athens, Greece
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Erjaee A, Niknam M, Sadeghi A, Dehghani M, Safaei Z, Teshnizi SH, Karimi M. A Significant Breakthrough in the Incidence of Childhood Cancers and Evaluation of its Risk Factors in Southern Iran. INDIAN JOURNAL OF MEDICAL AND PAEDIATRIC ONCOLOGY : OFFICIAL JOURNAL OF INDIAN SOCIETY OF MEDICAL & PAEDIATRIC ONCOLOGY 2017; 38:158-164. [PMID: 28900324 PMCID: PMC5582553 DOI: 10.4103/ijmpo.ijmpo_40_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background and Objective: This study investigates epidemiologic and practical information about the incidence and risk factors of childhood cancer in a population of Southern Iranian children. Materials and Methods: A total number of 300 cancer patients along with 600 age- and gender-matched healthy control were interviewed by a trained physician regarding their demographic characteristics, and major family-associated risk factors, childhood malignancies. Results: The average annual percentage change for cancers in the studied population is calculated as 45%. Our study indicated that possible risk factors which could contribute to the development of childhood cancer are maternal oral contraceptive pill use during pregnancy, exposure to radiation during pregnancy, parental smoking, residence near high voltage electricity lines, exposure to pesticides and fertilizers, patient allergy, contact with domestic animals and father's educational degree. Furthermore, new ecological risk factors such as air pollution due to nonstandard petroleum or toxic inhalant particles, nonhealthy food consumption, and satellite jamming are other predisposing factors. Conclusion: Our study reported a higher average annual percentage change of childhood cancers in our area, compared to the existing literature. In conclusion, detection and prevention of the consistent and possible new environmental risk factors such as nonstandard petroleum or satellite jamming from all around the country should be taking into consideration.
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Affiliation(s)
- Asma Erjaee
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Niknam
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmadreza Sadeghi
- Esthetic and Restorative Dentist, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Dehghani
- Department of Pharmacology and Toxicology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran
| | - Zeinab Safaei
- Department of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Hosseini Teshnizi
- Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Lins MM, Santos MDO, de Albuquerque MDFPM, de Castro CCL, Mello MJG, de Camargo B. Incidence and survival of childhood leukemia in Recife, Brazil: A population-based analysis. Pediatr Blood Cancer 2017; 64. [PMID: 28000427 DOI: 10.1002/pbc.26391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Leukemia is the most common pediatric cancer with incidence rates of around 48 per million for children under 15 years of age. The median age-adjusted incidence rate (AAIR) in children aged 0-14 years in Brazil is 53.3 per million. While overall survival rates for children with leukemia have improved significantly, data for incidence, trends, and relative survival among children and adolescents with leukemia in Recife, Brazil, remain incomplete, which hampers our analyses and provision of the best healthcare. The objective of this report is to provide that data. METHODS Data from the Population-Based Cancer Registry of Recife were analyzed from 1998 to 2007. Our analyses included frequencies and AAIR, together with age-specific incidence rates for all leukemias, acute lymphoblastic leukemia, and acute myeloid leukemia. To evaluate incidence trends, joinpoint regression, including annual average percent change, were analyzed. Relative survival was calculated using the life-table method. RESULTS One hundred seventy-five cases were identified, 51% in females. The review reduced the not otherwise specified (NOS) leukemia category by 50% and diagnosis by death certificate only from 5.7% to 1.1%. The AAIR for leukemia was 41.1 per million, with a peak among children aged 1-4 (78.3 per million). Incidence trends during the period were stable. The five-year relative survival rate was 69.8%. CONCLUSIONS These data represent the incidence rate and survival of childhood leukemia in Recife, located in the northeast region of Brazil, using a high-quality database.
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Affiliation(s)
- Mecneide Mendes Lins
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil.,Instituto Nacional de Cancer, Rio de Janeiro, Brazil.,Pediatric Oncology Unit, Instituto de Medicina Integral Prof. Fernando Figueira-IMIP, Recife, PE, Brazil
| | - Marceli de Oliveira Santos
- Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância (Surveilance Division and Surveilance and Prevention Coordination Situation of Analysis) at Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | | | | | - Maria Julia Gonçalves Mello
- Pediatric Research Center, Instituto de Medicina Integral Prof. Fernando Figueira - IMIP, Recife, PE, Brazil
| | - Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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de Jesus VHF, Ribeiro TN, Chinen LTD, Alves V, Curado MP, Fanelli MF. Epidemiological Profile and Treatment Outcomes in Young Adults (19-29 Years of Age) Treated for Cancer in a Tertiary Hospital in São Paulo, Brazil. J Adolesc Young Adult Oncol 2017; 6:333-340. [PMID: 28422548 DOI: 10.1089/jayao.2016.0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Worldwide, the incidence of cancer in young adults (20-39 years) is increasing, and represents an important cause of mortality in this age group. A retrospective study was undertaken to provide information that may lead to improved treatment outcomes. METHODS Epidemiological, clinicopathological, treatment, and survival information were retrieved from the electronic database registry of a tertiary referral hospital in São Paulo, Brazil for patients 19-29 years of age diagnosed with cancer between January 2007 and December 2012. RESULTS There were 960 patients with a median age at diagnosis of 26 years; female patients comprised 59.2%. A previous diagnosis of malignancy was present in 2.3%; 0.4% had malignant tumors that were radiation-associated; regular alcohol use was present in 10.4%; 9% of patients reported tobacco use; a family history of cancer was present in 41.7%. Malignant tumors included carcinomas (45.7%), germ cell and trophoblastic neoplasms (12.3%), and lymphomas (12.1%). Median follow-up was 47.7 months (range: 0.62-100.9 months) during which time 111 patients (13.5%) died. Carcinomas (n = 43, 38.7%), soft tissue sarcomas (n = 18, 16.2%), and leukemias (n = 10, 9.0%) were the most common causes of death. CONCLUSIONS This study has shown that carcinomas represent the most common malignancy in adolescents and young adults referred to a tertiary cancer center in Brazil and are the most common cause of mortality. Because clinical outcome may be affected by multiple factors in this patient population, further global studies are needed to characterize this population and improve clinical care.
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Affiliation(s)
| | - Taynan Nunes Ribeiro
- 1 Department of Medical Oncology, A.C. Camargo Cancer Center , São Paulo, Brazil
| | | | - Vanessa Alves
- 2 International Research Center, A.C. Camargo Cancer Center , São Paulo, Brazil
| | - Maria Paula Curado
- 2 International Research Center, A.C. Camargo Cancer Center , São Paulo, Brazil
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Ahmad Z, Idrees R, Fatima S, Uddin N, Ahmed A, Minhas K, Memon A, Fatima SS, Arif M, Hasan S, Ahmed R, Pervez S, Kayani N. Commonest Cancers in Pakistan - Findings and Histopathological Perspective from a Premier Surgical Pathology Center in Pakistan. Asian Pac J Cancer Prev 2017; 17:1061-75. [PMID: 27039726 DOI: 10.7314/apjcp.2016.17.3.1061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
CONTEXT There are no recent authoritative data about incidence and prevalence of various types of cancers in Pakistan. AIM To determine the frequency of malignant tumors seen in our practice and provide a foundation for building a comprehensive cancer care strategy. MATERIALS AND METHODS 10,000 successive cases of solid malignant tumors reported in 2014 were included. All cases had formalin fixed, paraffin embedded specimens available and diagnosis was based on histological examination of H and E stained slides plus ancillary studies at the Section of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi. The latest WHO classifications were used along with the latest CAP protocols for reporting and the most updated TNM staging. RESULTS There were 9,492 (94.9%) primary tumors while 508 (5.1%) were metastatic. Some 5,153 (51.5%) were diagnosed in females and 4,847 (48.5%) in males. The commonest malignant tumors in females were breast (32%), esophagus (7%), lymphomas (6.8%), oral cavity (6.7%) and ovary (4.8%), while in males they were oral cavity (13.9%), lymphomas (12.8%), colorectum (7.9%), stomach (6.9%) and esophagus (6.6%). Malignant tumors were most common in the 5th, 6th and 7th decades. About 8% were seen under 20 years of age. CONCLUSIONS Oral cavity and gastrointestinal cancers continue to be extremely common in both genders. Breast and esophageal cancers are prevalent in females. Lung and prostate cancer are less common than in the west. Ovarian cancer was very common but cervix cancer was less so.
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Affiliation(s)
- Zubair Ahmad
- Pathology and Laboratory Medicine, Histopathology, Aga Khan University Hospital, Karachi, Pakistan E-mail :
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Mattosinho CCDS, Grigorovski N, Lucena E, Ferman S, Soares de Moura ATM, Portes AF. Prediagnostic Intervals in Retinoblastoma: Experience at an Oncology Center in Brazil. J Glob Oncol 2016; 3:323-330. [PMID: 28831440 PMCID: PMC5560453 DOI: 10.1200/jgo.2016.005595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose Retinoblastoma is the most common intraocular malignancy of childhood. In most cases, parents are the first to notice leukocoria and other symptoms before undergoing a prolonged period of stress before diagnosis. The purpose of this study was to determine prediagnostic intervals of patients with retinoblastoma at an oncology tertiary center (Instituto Nacional de Cancer) in Rio de Janeiro, Brazil, and relate them to stage at diagnosis, eye salvage, and survival. Methods Parents or caregivers of children with retinoblastoma registered between January 2006 and September 2013 were interviewed using a semistructured individually applied questionnaire, concerning their trajectory before registration. Results Out of 76 patients, 39 (51%) were girls, 52 (68%) had unilateral retinoblastoma, and 24 (32%) had bilateral retinoblastoma, totaling 100 affected eyes. The most common stage of diagnosis was the intraocular group, with 63 (83%) patients; nine (12%) were extraocular, and four (5%) had metastatic disease. During the follow-up time of 37 ± 24.5 months, 10 (13%) patients died and 70 (70%) eyes were enucleated. Mean family interval was 1.6 ± 2.6 months, mean medical interval was 5.0 ± 6.2 months, mean referral interval was 0.2 ± 1.4 months, and mean overall interval was 7.1 ± 6.9 months. In univariate analysis, age at diagnosis, maternal education, medical interval, and overall interval were significantly related to advanced stage at diagnosis and survival. In multivariate analysis, maternal education and medical interval were significantly related to advanced stage at diagnosis and survival. No variables affected eye salvage. Conclusion Medical interval was responsible for 70% of the overall interval; therefore, programs or campaigns targeting retinoblastoma early diagnosis should focus emphasize in medical awareness.
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Affiliation(s)
| | - Nathalia Grigorovski
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Evandro Lucena
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sima Ferman
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Arlindo Freire Portes
- Instituto Nacional de Câncer; Universidade Estácio de Sá; and Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
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Jawass MA, Al-Ezzi JI, Bin Gouth HS, Bahwal SA, Bamatraf FF, Ba'amer AA. Pattern of malignancies in children <15 years of age reported in Hadhramout Cancer Registry, Yemen between 2002 and 2014. Saudi Med J 2016; 37:513-20. [PMID: 27146613 PMCID: PMC4880650 DOI: 10.15537/smj.2016.5.14954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 02/26/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To describe the patterns of childhood cancers in Hadhramout Sector, Yemen between January 2002 and December 2014. METHODS This descriptive retrospective study was based on secondary data from Hadhramout Cancer Registry, Hadhramout, Yemen. All Yemeni children under age of 15 years, who were diagnosed with cancer were included. The International Childhood Cancer Classification system was used to categorize cancer types. RESULTS A total of 406 childhood cancers of both gender less than 15 years of age were reported. These represented 8.5% of all cases registered. The mean age was 7.34 ± 4.18 years. There were 240 males (59.1%) and 166 females (40.9%) with a male to female ratio of 1.4:1. Calculated incidence of cancer in children in this population is 1.9 per 100,000. The predominant age group was 5-9 years (35%) followed by 10-14 years (33.7%), and 0-4 years group (31%). The most common group of malignancies were hematological malignancies accounting for 47% of cases, followed by nervous system malignancies (15%). The most frequently reported cancer types were lymphoma (24%), leukemia (23%), carcinoma (13.1%), and central nervous system (CNS) tumors (11.6%). CONCLUSIONS There is a lower frequency of childhood cancer in Hadhramout Sector when compared with developed countries. The most common cancers among children were lymphoma, leukemia, carcinoma, and CNS tumors.
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Affiliation(s)
- Mazin A Jawass
- Department of Pediatrics, College of Medicine, Hadhramout University, Al-Mukalla, Hadhramout, Yemen. E-mail.
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Abstract
Background Retinoblastoma (Rb) is the most common intraocular tumor diagnosed in children in Brazil. However, detailed information is lacking regarding patient clinical demographics. This study aimed to determine the clinical profile of patients with Rb who were treated in a public university hospital in southern Brazil from 1983 to 2012. Methods: Patients’ medical records were reviewed to retrospectively identify patients with a principal diagnosis of Rb. Rb was classified as hereditary or non-hereditary. Clinical staging was reviewed by an ophthalmologist. Statistical analysis was performed using SPSS. Results Of 165 patients with a diagnosis of Rb during this period, 140 were included in the study. Disease was unilateral in 65.0 % of patients, bilateral in 32.9 %, and trilateral in 2.1 %. The mean age at onset of the first sign/symptom was 18.1 month, and 35.7 % of patients were diagnosed during the first year of life. The most common presenting signs were leukocoria (73.6 %) and strabismus (20.7 %). The mean age at diagnosis was 23.5 months, and time to diagnosis was 5.4 months. In patients with clinical features of hereditary Rb, both onset of the first sign/symptom and diagnosis were at an earlier age than in patients without these features (12.3 vs 21.6 months [P = 0.001] and 15.9 vs 28.0 months [P < 0.001], respectively). However, there was no significant difference in overall survival between the two groups. Ocular stage at diagnosis was advanced in 76.5 % (Reese V) and 78.1 % (International Classification D or E). Of patients with unilateral and bilateral disease, 35.2 % and 34.8 %, respectively, had extraocular disease at diagnosis; 10.7 % had metastatic disease at diagnosis. Enucleation was observed in 88.1 % and exenteration in 11.9 % of patients; 93.6 % patients were followed until 2012, and 22.9 % relapsed. Overall survival was 86.4 %. Conclusions Most Rb diagnoses are still diagnosed in advanced stages of the disease, considerably reducing overall survival time and the rate of eye and vision preservation. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0579-9) contains supplementary material, which is available to authorized users.
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Pinto RB, Ramos ARL, Backes AN, dos Santos BJ, Provenzi VO, Carbonera MR, Roenick ML, dos Santos PPA, Falhauber F, de Souza MV, Bassols JV, Artigalás O. Hirschsprung disease and hepatoblastoma: case report of a rare association. SAO PAULO MED J 2016; 134:171-5. [PMID: 26465815 PMCID: PMC10496547 DOI: 10.1590/1516-3180.2014.9200311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/07/2014] [Accepted: 11/03/2014] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Hirschsprung disease is a developmental disorder of the enteric nervous system that is characterized by absence of ganglion cells in the distal intestine, and it occurs in approximately 1 in every 500,000 live births. Hepatoblastoma is a malignant liver neoplasm that usually occurs in children aged 6 months to 3 years, with a prevalence of 0.54 cases per 100,000. CASE REPORT A boy diagnosed with intestinal atresia in the first week of life progressed to a diagnosis of comorbid Hirschsprung disease. Congenital cataracts and sensorineural deafness were diagnosed. A liver mass developed and was subsequently confirmed to be a hepatoblastoma, which was treated by means of surgical resection of 70% of the liver volume and neoadjuvant chemotherapy (ifosfamide, cisplatin and doxorubicin). CONCLUSION It is known that Hirschsprung disease may be associated with syndromes predisposing towards cancer, and that hepatoblastoma may also be associated with certain congenital syndromes. However, co-occurrence of hepatoblastoma and Hirschsprung disease has not been previously described. We have reported a case of a male patient born with ileal atresia, Hirschsprung disease and bilateral congenital cataract who was later diagnosed with hepatoblastoma.
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Affiliation(s)
- Raquel Borges Pinto
- MD. Physician, Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ana Regina Lima Ramos
- MD. Physician, Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ariane Nadia Backes
- MD. Physician, Department of Pediatric Surgery, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Beatriz John dos Santos
- MD. Physician, Department of Pediatric Gastroenterology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Valentina Oliveira Provenzi
- MD. Physician, Department of Pathological Anatomy, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Mário Rafael Carbonera
- MD. Physician, Department of Pediatric Surgery, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Maria Lúcia Roenick
- MD. Resident, Department of Pediatric Surgery, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Pedro Paulo Albino dos Santos
- MD. Physician, Department of Pediatric Oncology and Hematology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Fabrizia Falhauber
- MD. Physician, Department of Pediatric Oncology and Hematology, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Meriene Viquetti de Souza
- MD. Resident, Department of Pediatrics, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - João Vicente Bassols
- MD. Physician, Department of Pediatric Surgery, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Osvaldo Artigalás
- MD. Physician, Department of Medical Genetics, Hospital da Criança Conceição, Grupo Hospitalar Conceição (GHC), Porto Alegre, Rio Grande do Sul, Brazil.
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Abstract
The spectrum of cancers commonly found in adolescents and young adults (AYAs) differs from those in children and adults; therefore, the childhood classification is not appropriate for this population. Here we used a newly proposed classification system to reclassify cases of AYAs from Brazilian population-based cancer registries (PBCRs) in 5 geographic regions of Brazil. We aimed to describe the cancer incidence rates within this age group according to PBCR. Using the world population, incidence rates per million were analyzed in each diagnostic subgroup according to sex and age at diagnosis (15 to 19 y, 20 to 24 y, and 25 to 29 y). The median incidence rate was 232.31 per million for females and 218.07 per million for males. Incidence increased with age, with the highest rate observed for 25- to 29-year-olds in both sexes. Carcinomas, lymphomas, and skin tumors were most frequent among AYAs. High incidence rates of cervix-uterus carcinoma were observed in most PBCRs. AYAs present epidemiological characteristics that differ from those of children, reinforcing the need for a new classification. This study describes, for the first time, the cancer incidence rate in AYAs in Brazil, and we believe that our findings represent the Brazilian profile.
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Clinical presentation of intraocular retinoblastoma; 5-year hospital-based registry in Egypt. J Egypt Natl Canc Inst 2015; 27:195-203. [DOI: 10.1016/j.jnci.2015.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 08/31/2015] [Accepted: 09/10/2015] [Indexed: 01/26/2023] Open
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Arruda-Colli M, Perina E, Santos M. Experiences of Brazilian children and family caregivers facing the recurrence of cancer. Eur J Oncol Nurs 2015; 19:458-64. [DOI: 10.1016/j.ejon.2015.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/07/2015] [Accepted: 02/09/2015] [Indexed: 12/14/2022]
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Moreno F, Dussel V, Orellana L. Childhood cancer in Argentina: Survival 2000–2007. Cancer Epidemiol 2015; 39:505-10. [DOI: 10.1016/j.canep.2015.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 03/20/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
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Abstract
Retinoblastoma is the most common neoplasm of the eye in childhood, and represents 3% of all childhood malignancies. Retinoblastoma is a cancer of the very young; two-thirds are diagnosed before 2 years of age and 95% before 5 years. Retinoblastoma presents in 2 distinct clinical forms: (1) a bilateral or multifocal, heritable form (25% of all cases), characterized by the presence of germline mutations of the RB1 gene; and (2) a unilateral or unifocal form (75% of all cases), 90% of which are nonhereditary. The treatment of retinoblastoma is multidisciplinary and is designed primarily to save life and preserve vision.
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Affiliation(s)
- Carlos Rodriguez-Galindo
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, 450 Brookline Avenue, D3-133, Boston, MA 02215, USA.
| | - Darren B Orbach
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02215, USA
| | - Deborah VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02215, USA
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Hermont AP, Scarpelli AC, Paiva SM, Auad SM, Pordeus IA. Anxiety and worry when coping with cancer treatment: agreement between patient and proxy responses. Qual Life Res 2014; 24:1389-96. [PMID: 25447884 DOI: 10.1007/s11136-014-0869-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Assess agreement between proxy respondents (caregivers) and children/adolescents related to the impact of cancer on children's/adolescents' health-related quality of life, with respect to anxiety and worry issues. METHODS A cross-sectional study was conducted among 83 Brazilian children/adolescents, of both genders, diagnosed with cancer, aged 5-18 years and their proxy respondents. Anxiety and worry were assessed through items of the instrument Pediatric Quality of Life Inventory™ Cancer Module Scale. Participants were recruited from the pediatric hematology/oncology centers at two public hospitals. All individuals were receiving medical care. Descriptive statistics were performed as well as a weighted kappa coefficient, Spearman's correlation coefficient, Wilcoxon signed-rank test and Bland-Altman plots. The magnitude of the difference between the mean scores obtained from children/adolescents and that of their proxy respondents was evaluated through effect size. RESULTS The proxy respondents underestimated the feelings of worry among children (8-12 years) (p < 0.001; effect size 0.71) and overestimated adolescents' (13-18 years) treatment anxiety (p < 0.05; effect size 0.57). The comparison between the three age groups (5-7, 8-12, 13-18 years) showed a tendency for children/adolescents to report increasing feelings of worry as they got older. In the 'treatment anxiety' subscale, there was a tendency for proxy respondents to present higher mean scores, revealing that proxy respondents believed the children's/adolescents' treatment anxiety decreased as they aged. CONCLUSIONS Discrepancies between the reports of children/adolescents and their proxy respondents were observed. Children's/adolescents' reports should not be ignored nor replaced by proxy reports; both reports should be analyzed together.
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Affiliation(s)
- Ana Paula Hermont
- Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, MG, 31270-901, Brazil,
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Hung GY, Horng JL, Lee YS, Yen HJ, Chen CC, Lee CY. Cancer incidence patterns among children and adolescents in Taiwan from 1995 to 2009: a population-based study. Cancer 2014; 120:3545-53. [PMID: 25043411 PMCID: PMC4232908 DOI: 10.1002/cncr.28903] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/13/2014] [Accepted: 06/05/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Currently, little information is available on childhood cancer incidence rates in Eastern Asia. The objective of this study was to report the first population-based cancer surveillance of children and adolescents in Taiwan. METHODS Data from the Taiwan Cancer Registry were examined for cancer frequencies and incidence rates among individuals ages birth to 19 years from 1995 to 2009. Types of cancers were grouped according to the International Classification of Childhood Cancer. Rates were compared by sex and age. For further comparisons with other countries, rates were age standardized to the 2000 world standard population in 5-year age groups. Trends in incidence rates also were evaluated. RESULTS In total, 12,315 individuals were diagnosed with childhood cancers, for an age-standardized incidence rate (ASR) of 132.1 per million person-years from 1995 to 2009. The male-to-female incidence rate ratio was 1.19. Overall, leukemias were the most common cancer (ASR, 39.1 per million person-years), followed by central nervous system neoplasms (15.8 per million person-years), and lymphomas (15.3 per million person-years). During the 15-year study period, the incidence rates increased by 1% annually. Compared with other countries, the rate of hepatic tumors was 2 times greater in Taiwan. The rate of germ cell neoplasms in Taiwan was similar to that in the United States and was 1.3 to 1.9 times greater compared with Canada, Brazil, Israel, and Japan. CONCLUSIONS Based on the current data, the observed increase in overall incidence rates was attributable only marginally to improvements in case ascertainment and diagnostic procedures. The high rates of malignant hepatic tumors and germ cell neoplasms in Taiwan suggest variations in the background risk factors.
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Affiliation(s)
- Giun-Yi Hung
- Division of Pediatric Hematology and Oncology, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Pediatrics, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of MedicineTaipei, Taiwan
| | - Jiun-Lin Horng
- Department of Anatomy, Taipei Medical UniversityTaipei, Taiwan
| | - Yu-Sheng Lee
- Department of Pediatrics, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of MedicineTaipei, Taiwan
- Institute of Public Health, National Yang-Ming University School of MedicineTaipei, Taiwan
| | - Hsiu-Ju Yen
- Division of Pediatric Hematology and Oncology, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Pediatrics, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of MedicineTaipei, Taiwan
| | - Chao-Chun Chen
- Division of Pediatric Hematology and Oncology, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Pediatrics, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of MedicineTaipei, Taiwan
| | - Chih-Ying Lee
- Division of Pediatric Hematology and Oncology, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Pediatrics, Taipei Veterans General HospitalTaipei, Taiwan
- Department of Pediatrics, National Yang-Ming University School of MedicineTaipei, Taiwan
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Moreno F, Sinaki B, Fandiño A, Dussel V, Orellana L, Chantada G. A population-based study of retinoblastoma incidence and survival in Argentine children. Pediatr Blood Cancer 2014; 61:1610-5. [PMID: 24729462 DOI: 10.1002/pbc.25048] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 03/10/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND An increased incidence of retinoblastoma in some developing countries has been reported but no conclusive data are available from population-based studies at national level. PURPOSE To report the incidence and survival of retinoblastoma in Argentina from the National Pediatric Cancer Registry (ROHA) and the influence of socio-economical indicators on outcome. PROCEDURE Cases reported to the ROHA (2000-2009) were analyzed. Incidence rates were calculated using National Vital Statistics and survival was estimated. The extended human development index (EHDI) was used as a socio-economical indicator. RESULTS With 438 patients reported, an incidence of 5.0 cases per million children 0-14 years old (95% CI 3.5-6.4) was calculated. Median age at diagnosis was significantly higher for children from provinces with lower EHDI; (24 vs. 35 months for unilateral, (P = 0.003) and 9 versus 11.5 months for bilateral retinoblastoma (P = 0.027). The 3-year probability of survival was 0.87 and 0.94 for unilateral and bilateral retinoblastoma, respectively. Residents in provinces with higher EHDI had a better 3-year survival (0.93 vs. 0.77 for lower EHDI, P < 0.0001). Probability of survival was higher for patients treated at tertiary level institutions (P = 0.0015). The combination of low EHDI residence province with no treatment at a tertiary institution was associated with the worst survival outcome. For both, unilateral and bilateral disease, children who died were in average diagnosed at older age. CONCLUSIONS The incidence of retinoblastoma in Argentina is comparable to that of developed countries. Retinoblastoma is diagnosed later and survival is lower in the less developed areas of the country.
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Affiliation(s)
- Florencia Moreno
- Registro Onco-pediatrico Hospitalario Argentino (ROHA, Hospital-based Pediatric Cancer Registry from Argentina), Instituto Nacional del Cáncer, Buenos Aires, Argentina
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Provenzi VO, Rosa RFM, Rosa RCM, Roehe AV, dos Santos PPA, Faulhaber FRS, de Oliveira CAV, Zen PRG. Wilms tumor: experience of a hospital in southern Brazil. Pediatr Int 2014; 56:534-40. [PMID: 24447407 DOI: 10.1111/ped.12295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 09/25/2013] [Accepted: 12/26/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wilms tumor (WT) is the most common renal malignancy of childhood. The aim of this study was to verify the epidemiological profile and prognosis of a sample of patients from Brazil and compare them to similar data from other Latin American studies. METHOD The sample consisted of consecutive patients diagnosed with WT in an oncohematology service of a referral hospital in Southern Brazil, between 1989 and 2009. Clinical, radiological, pathological and survival data were collected from the medical records. Analysis was done using Excel and SPSS version 18.0. The significance level was set at P < 0.05. RESULTS The final sample consisted of 45 patients. The male/female ratio was 1.25:1. Mean age at diagnosis was 43.9 months and all patients were of European descent. Thirty-three patients (73.3%) had both signs/symptoms of abdominal mass and hypertension. Malformation was observed in nine patients (20%) and there was one case of Fanconi's anemia (2.2%). Three patients had bilateral disease (6.7%). The majority of patients had stage III and IV (62.2%). Patients with malformation had an earlier age at diagnosis (P = 0.018) and a higher prevalence of bilateral disease (P = 0.044). Overall survival was 75%. Age at diagnosis was the only significant independent predictor associated with death. CONCLUSION Death is closely related to late diagnosis in WT. Oncologic services should also be concerned about morbidity caused by therapeutic options in cases of late diagnosis, and the consequences for quality of life.
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Baharvand M, Mortazavi H. Characteristics of Hodgkin Lymphoma in a Defined Group of Iranian Pediatric Patients. Asian Pac J Cancer Prev 2014; 15:5167-9. [DOI: 10.7314/apjcp.2014.15.13.5167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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PON1 Q192R polymorphism (rs662) is associated with childhood embryonal tumors. Mol Biol Rep 2014; 41:6111-5. [PMID: 24972570 DOI: 10.1007/s11033-014-3489-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
Genetic susceptibility and environment exposures are associated risk factors in carcinogenesis. Gene polymorphisms that decrease the activity of detoxifying carcinogen substances may modify the effect of exposures. We investigated whether the polymorphisms PON1 rs662 (Q192R), and PON1 rs854560 (L55M) would be associated with embryonal tumors in Brazilian children. Blood samples from 163 children with embryonal tumors and 342 as control group were genotyped by TaqMAN real-time PCR assays. Logistic regression was used to evaluate the association between the polymorphisms of cases and controls groups, adjusted by skin color and age strata. When all tumors were taken together, the presence of the PON1 rs662 (Q192R) variant genotype (RR) was associated with an increased risk of developing embryonal tumors (OR = 2.80, 95 % CI 1.12-7.02). The presence of at least one variant PON1 rs662 R allele increased the risk of developing Wilms´ Tumor although without statistical power. However, it was observed a significant association of PON1 rs662 (Q192R) variant genotype (RR) with retinoblastoma (OR = 4.08, 95 % CI 1.13-14.97), whereas the PON1 rs854560 (L55M) polymorphism was not associated with any tumor. These results indicate that PON1 polymorphisms may have an influence on the risk of developing embryonal tumors.
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Sandrone SS, Repossi G, Candolfi M, Eynard AR. Polyunsaturated fatty acids and gliomas: a critical review of experimental, clinical, and epidemiologic data. Nutrition 2014; 30:1104-9. [PMID: 24976422 DOI: 10.1016/j.nut.2014.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 01/12/2014] [Indexed: 01/25/2023]
Abstract
Certain polyunsaturated fatty acids (PUFAs) called essential fatty acids (EFAs) cannot be biosynthesized by the body and hence, need to be obtained from diet. These PUFAs and their metabolites have multiple physiological functions that are altered in tumor cells due to a decreased expression of Δdelta-6-desaturase, which is an essential step in their metabolism. As a result, tumor cells would be protected from the toxic effect caused by free radicals, one product of EFA metabolism. EFAs have been proposed to have therapeutic potential in the treatment of glioblastoma. Gliomas are the most common primary tumors of the central nervous system in children and adults. High-grade gliomas remain a therapeutic challenge in neuro-oncology because there is no treatment that achieves a significant improvement in survival. Novel therapeutic strategies that use PUFAs for the treatment of gliomas have been assessed in cell cultures, rodent glioma models, and humans, with encouraging results. Here we review the latest progress made in the field.
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Affiliation(s)
- Silvana Silvia Sandrone
- Biología Celular, Histología y Embriología, Facultad de Ciencias Médicas, INICSA (CONICET-Universidad Nacional de Córdoba), Córdoba, Argentina; Servicio de Patología, Hospital Rawson de Córdoba, Córdoba, Argentina
| | - Gaston Repossi
- Biología Celular, Histología y Embriología, Facultad de Ciencias Médicas, INICSA (CONICET-Universidad Nacional de Córdoba), Córdoba, Argentina; Cátedra de Histología, Embriología y Genética, Universidad Nacional de La Rioja, La Rioja, Argentina
| | - Marianela Candolfi
- Instituto de Investigaciones Biomédicas, Facultad de Medicina, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina; CONICET-Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Aldo Renato Eynard
- Biología Celular, Histología y Embriología, Facultad de Ciencias Médicas, INICSA (CONICET-Universidad Nacional de Córdoba), Córdoba, Argentina; CONICET-Universidad Nacional de Córdoba, Córdoba, Argentina.
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Cipreste MF, Sousa EMB. Poly(Vinyl Alcohol)/Collagen/Hydroxyapatite Nanoparticles Hybrid System Containing Yttrium-90 as a Potential Agent to Treat Osteosarcoma. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/jbnb.2014.51004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dénes FT, Duarte RJ, Cristófani LM, Lopes RI. Pediatric genitourinary oncology. Front Pediatr 2013; 1:48. [PMID: 24400293 PMCID: PMC3864259 DOI: 10.3389/fped.2013.00048] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/02/2013] [Indexed: 02/03/2023] Open
Abstract
Tumors of the kidney, bladder, prostate, testis, and adrenal represent a large part of the adult urologic practice, but are relatively infrequent in children. The natural history and management of these tumors in the pediatric age is different from that of the adults. As result of the successful work of several clinical trial groups in recent decades, there has been a significant improvement in their cure rates. The aim of this article is to review their most significant clinical aspects, as well as to present an update in their management.
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Affiliation(s)
- Francisco Tibor Dénes
- Uropediatric Unit, Division of Urology, Hospital das Clínicas, University of São Paulo , São Paulo , Brazil
| | - Ricardo Jordão Duarte
- Uropediatric Unit, Division of Urology, Hospital das Clínicas, University of São Paulo , São Paulo , Brazil
| | - Lílian Maria Cristófani
- Pediatric Onco-Hematology Unit, Department of Pediatrics, Hospital das Clínicas, University of São Paulo , São Paulo , Brazil
| | - Roberto Iglesias Lopes
- Uropediatric Unit, Division of Urology, Hospital das Clínicas, University of São Paulo , São Paulo , Brazil
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Zouain-Figueiredo GP, Zandonade E, Amorim MHC. Cancer survival among children and adolescents at a state referral hospital in southeastern Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2013. [DOI: 10.1590/s1519-38292013000400006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES: to analyze the patient characteristics and evaluate overall survival, survival according to demographic variables, the most common tumor groups and subgroups, the stages of disease, and risk factors after at least 5 years among children and adolescents with cancer who were admitted to a state referral hospital between 2000 and 2005. METHODS: the Kaplan-Meier method was employed to estimate survival. The survival curves were compared using the log-rank test. The Cox regression model was used to estimate the effect of independent variables. RESULTS: a total of 571 new cases were registered. The most frequent cancer groups were leukemia (34%), lymphoma (18%), and central nervous system (CNS) tumors (15%).The overall survival rate was 59%. The risk factors associated with lower survival were an age of more than 4 years or less than 1 year, the presence of CNS tumors, and non-localized disease. CONCLUSION: although this was not a populationbased study, it provides important epidemiological information about a state where population data on childhood and adolescent cancer are scarce and where hospital-based data do not exist. The survival rate found here should serve as a framework for future improvements, helping to guide policymakers focused on pediatric oncology in the state.
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Childhood cancer in Aden, Yemen. Cancer Epidemiol 2013; 37:803-6. [PMID: 24211152 DOI: 10.1016/j.canep.2013.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/22/2013] [Accepted: 10/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cancer in children is increasingly recognized as a major and growing health problem in different developed and developing countries. In Yemen, it is still difficult to know the extent of cancer and its determinants among children. This study was conducted to determine the magnitude of childhood cancer in Aden and provide the preliminary baseline data by age and sex. METHODS Basic epidemiologic data was retrieved from all paediatric cancer <15 years age registered in Aden Caner Registry (ACR), Yemen, from 1997 to 2006. RESULTS The results showed a total of 483 childhood cancers <15 years age comprising 12.7% of all registered malignancies with a male to female ratio of 1.5:1. The predominant age affected was 5-9 years in (38.3%) children. The most frequent cancer among Yemeni children was leukaemia 160 (33.1%) followed by lymphoma 152 (31.5%), CNS tumors 35 (7.2%) and bone tumours 25 (5.2%). An interesting and unusual finding was the frequency of acute myeloid leukaemia twice more common in female (66.7%) than male (33.3%). Lymphoma was the most common cancer in children >5 years. An interesting comparison was the preponderance of non-Hodgkins's lymphoma over Hodgkin's disease (1.6:1) stronger in female (3:1) than male (1.25:1). Medulloblastoma was the most common CNS tumour followed by astrocytoma, an infrequent finding in childhood cancer. Osteosarcoma was the most frequent bone tumour (male:female ratio of 1.8:1). A female preponderance was noticed in chondrosarcoma that was not yet documented. The blastoma group was common in younger age group. Retinoblastoma and nephroblastoma predominated in female while neuroblastoma, hepatoblastoma and soft tissue sarcomas in male. CONCLUSION It is concluded that there is a lower frequency of childhood cancer in Aden when compared with developed countries. It may explained by the fact that a large number of childhood cancers remain undiagnosed due to limitations of diagnostic facilities or under registration. Central paediatric hospitals should be provided with essential diagnostic and therapeutic services that should be freely available to all children with cancer.
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Carvalho INSR, Reis AHDO, Cabello PH, Vargas FR. Polymorphisms of CDKN1A gene and risk of retinoblastoma. Carcinogenesis 2013; 34:2774-7. [PMID: 24045412 DOI: 10.1093/carcin/bgt308] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
UNLABELLED Retinoblastoma (RB) is a malignant neoplasia that occurs mostly in children under 5 years. Recently, CDKN1A gene has been shown to be up-regulated in a context of loss of function of pRb. This gene encodes the p21 protein, which is the bona fide effector of p53. We hypothesized whether two putatively functional single nucleotide polymorphisms (SNPs) of CDKN1A (rs1801270 C>A and rs1059234 C>T) may influence the risk and/or survival of RB patients. We genotyped both SNPs in 141 RB patients and 120 unrelated healthy individuals. Statistical analyses consisted of chi-square (χ(2)), odds ratio (OR) and survival curves by Kaplan-Meier method. We found that patients who carry the genotype CA for rs1801270 and CT for rs1059234 were associated to an increased risk of RB [OR = 2.5, 95% confidence interval (CI) = 1.38-4.53], whereas patients with CC for both polymorphisms were associated to a lower risk of developing RB (OR = 0.43, 95% CI = 0.25-0.74). On the other hand, Kaplan-Meier curves did not show statistically significant differences in survival among the studied polymorphisms. We conclude that the minor alleles of rs1801270 and rs1059234 polymorphisms may act as risk factors for the development of RB in our sample. SUMMARY The minor alleles of polymorphisms rs1801270 C>A and rs1059234 C>T in CDKN1A (p21) gene may act as risk factors for the development of RB; however, they do not seem to influence overall survival.
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Affiliation(s)
- Ivna Néria Silva Ribamar Carvalho
- Genetics and Molecular Biology Department, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), 20211-040 Rio de Janeiro, Brazil
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Grabois MF, de Oliveira EXG, Sa Carvalho M. Assistencia ao cancer entre criancas e adolescentes: mapeamento dos fluxos origem-destino no Brasil. Rev Saude Publica 2013; 47:368-78. [DOI: 10.1590/s0034-8910.2013047004305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 09/09/2012] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Analisar os fluxos de viagens de crianças e adolescentes com câncer, entre os locais de residência e serviço de saúde. MÉTODOS: Foram analisados os fluxos de viagens de crianças e adolescentes com câncer entre os locais de residência e de serviço de saúde atendidos no Sistema Único de Saúde (SUS), de 2000 a 2007. A unidade de análise foi a regional de saúde. Utilizou-se o sistema de informações geográficas e metodologia de redes por tipo de tratamento recebido (quimioterapia e radioterapia) e internações hospitalares. RESULTADOS: Foram emitidas 465.289 autorizações de quimioterapia, 29.151 de radioterapia e 383.568 de internações hospitalares de crianças e adolescentes com diagnóstico de câncer para tratamento no SUS. O fluxo dominante formou 48 redes para quimioterapia, 53 para radioterapia e 112 para internações hospitalares. A maior parte do volume de atendimento ocorreu nas regionais de saúde das 12 maiores metrópoles do País com grande relacionamento entre elas e extensa área de influência direta acompanhando a estrutura da rede urbana brasileira. CONCLUSÕES: A identificação das redes estabelecidas no âmbito do SUS para o atendimento de crianças e adolescentes com câncer mostra que a maioria dos pacientes está contemplada pelas redes estruturadas. Cerca de 10% das viagens ocorrem fora do fluxo dominante, indicando a necessidade de regionalização alternativa. Os resultados evidenciam a importância do planejamento da distribuição dos serviços de acordo com as necessidades da população usuária.
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