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Ward R, Jones HM, Witt D, Boop F, Bouffet E, Rodriguez-Galindo C, Qaddoumi I, Moreira DC. Outcomes of Children With Low-Grade Gliomas in Low- and Middle-Income Countries: A Systematic Review. JCO Glob Oncol 2022; 8:e2200199. [PMID: 36198134 PMCID: PMC9812478 DOI: 10.1200/go.22.00199] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Pediatric CNS tumors are increasingly a priority, particularly with the WHO designation of low-grade glioma (LGG) as one of six index childhood cancers. There are currently limited data on outcomes of pediatric patients with LGGs in low- and middle-income countries (LMICs). METHODS To better understand the outcomes of LGGs in LMICs, this systematic review interrogated nine literature databases. RESULTS The search identified 14,977 publications. Sixteen studies from 19 countries met the selection criteria and were included for data abstraction and analysis. Eleven studies (69%) were retrospective reviews from single institutions, and one (6%) captured institutional data prospectively. The studies captured a total of 957 patients with a median of 49 patients per study. Seven (44%) of the studies described the treatment modalities used. Of 373 patients for whom there was information, 173 (46%) had a gross total or near total resection, 109 (29%) had a subtotal resection, and 91 (24%) had only a biopsy performed. Seven studies, with a total of 476 patients, described the frequency of use of radiotherapy and/or chemotherapy in the cohorts: 83 of these patients received radiotherapy and 76 received chemotherapy. The 5-year overall survival ranged from 69.2% to 93.5%, although lower survival rates were reported at earlier time points. We identified limitations in the published studies with respect to the cohort sizes and methodologies. CONCLUSION The included studies reported survival rates frequently exceeding 80%, although the ultimate number of studies was limited, pointing to the paucity of studies describing the outcomes of children with LGGs in LMICs. This study underscores the need for more robust data on outcomes in pediatric LGG.
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Affiliation(s)
- Richard Ward
- University of Tennessee Health Science Center College of Medicine, Memphis, TN
| | - Hannah M. Jones
- Texas Tech University Health Science Center School of Medicine, Lubbock, TX
| | - Davis Witt
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Frederick Boop
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Eric Bouffet
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN
| | - Daniel C. Moreira
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, TN,Daniel C. Moreira, MD, MEd, Department of Global Pediatric Medicine, St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 721, Memphis, TN 38105; Twitter: @DanielMoreiraMD; e-mail:
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Moreira DC, Gajjar A, Patay Z, Boop FA, Chiang J, Merchant TE, Santiago T, Schaeffer E, Sonnenfelt J, Andujar A, Shuler A, Caniza MA, Rodriguez-Galindo C, Qaddoumi I. Creation of a successful multidisciplinary course in pediatric neuro-oncology with a systematic approach to curriculum development. Cancer 2020; 127:1126-1133. [PMID: 33259071 DOI: 10.1002/cncr.33350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The St Jude Global Academy Neuro-Oncology Training Seminar (NOTS) is a hybrid course in pediatric neuro-oncology specifically designed for physicians from low-income and middle-income countries. METHODS The curriculum for the course was created by conducting a targeted needs assessment that evaluated 11 domains of care for children with central nervous system (CNS) tumors. The targeted needs assessment was completed by 24 institutions across the world, and the data were used to define 5 core elements included in the 2 components of the NOTS: a 9-week online course and a 7-day in-person workshop. Participant acquisition of knowledge and changes in clinical behavior were evaluated as measures of success. RESULTS Teams from 8 institutions located in 8 countries enrolled in the online course, and it was successfully completed by 36 participants representing 6 specialties. On the basis of their performance in the online course, 20 participants from 7 institutions took part in the on-site workshop. The participants exhibited improved knowledge in core elements of treating children with CNS tumors, including barriers of care, possible solutions, and steps for project implementation (P < .0001). All participants expressed a belief that they acquired new concepts and knowledge, leading to changes in their clinical practice. Those present at the workshop created an international multidisciplinary group focused on treating CNS tumors in low-income and middle-income countries. CONCLUSIONS By using a hybrid online and in-person approach, the authors successfully created a multidisciplinary course focused on pediatric CNS tumors for resource-limited settings. Their experience supports this strategy as a feasible mechanism for driving further global collaborations.
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Affiliation(s)
- Daniel C Moreira
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Zoltan Patay
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Frederick A Boop
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jason Chiang
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Teresa Santiago
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Elizabeth Schaeffer
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Jason Sonnenfelt
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Allyson Andujar
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Ana Shuler
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Miguela A Caniza
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Carlos Rodriguez-Galindo
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
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Barragán-Pérez EJ, Altamirano-Vergara CE, Alvarez-Amado DE, García-Beristain JC, Chico-Ponce-de-León F, González-Carranza V, Juárez-Villegas L, Murata C. The Role of Time as a Prognostic Factor in Pediatric Brain Tumors: a Multivariate Survival Analysis. Pathol Oncol Res 2020; 26:2693-2701. [PMID: 32661835 DOI: 10.1007/s12253-020-00875-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/09/2020] [Indexed: 12/29/2022]
Abstract
There is no evidence that prolonged pre diagnostic symptomatic intervals (PSI) increases the risk of death in pediatric brain tumors. When investigating the role of time previous research had not controlled for confounding variables or measured the pretreatment interval (PTI). We use the term global delay interval (GDI) to describe the sum of PSI and PTI. The aim of this research was to evaluate whether there was a decrease in the probability of survival in children with brain tumors due to a prolonged PSI, PTI and GDI, using a multivariate survival analysis. We retrospective review 127 clinical records labeled with the diagnosis of CNS tumors attended at a specialized pediatric center in Mexico City from January 2008 to December 2012. Patients with PSI and GDI diagnosed between 3 and 6 months showed statistical lower probability of surviving that those with intervals <3 months even when adjusting for age, sex, localization and tumor grade. When stratified for the place of residency and adjusted for sex, age, localization, grade of tumor, type of surgery and coadjuvant therapy, a GDI between 3 and 6 months showed to be a risk factor for the overall survival of brain tumors compared with an interval < 3 months. When analyzing the interaction, high grade tumors are at more risk of dying when GDI was between 3 and 6 months compared to <3 months. Prolonged PSI and GDI showed to be a potential prognostic factor for survival in CNS tumors, especially in high grade tumors. Future prospective research should measure the PSI, PTI and GDI and adjust for covariates in order to properly infer the effect of time in pediatric brain tumors.
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Affiliation(s)
| | | | - Daniel Eduardo Alvarez-Amado
- Pediatric Neurology Department "Hospital Infantil de México Federico Gómez", Mexico City, Mexico. .,Hospital Infantil de México Federico Gómez, Calle Doctor Márquez 162, Alcadía Doctores, Cuauhtémoc, 06720, Ciudad de México, Mexico.
| | | | | | | | - Luis Juárez-Villegas
- Pediatric Oncology Department "Hospital Infantil de México Federico Gómez", Mexico City, Mexico
| | - Chiharu Murata
- Research Methodology Department, Instituto Nacional de Pediatria, Mexico City, Mexico
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Epidemiology of Nervous System Tumors According to WHO 2007 Classification: A Report of 1,164 Cases from a Single Hospital. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.11462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mehrvar A, Tashvighi M, Hedayati Asl AA, Niktoreh-Mofrad N, Mehrvar N, Afsar N, Naderi A, Allebouyeh M, Qaddoumi I, Faranoush M. Management and outcomes of treating pediatric medulloblastoma: an eight years' experience in an Iranian pediatric center. Childs Nerv Syst 2018; 34:639-647. [PMID: 29214340 DOI: 10.1007/s00381-017-3672-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 11/27/2017] [Indexed: 12/30/2022]
Abstract
PURPOSE The clinical management of pediatric medulloblastoma requires a multidisciplinary approach, which can be challenging, especially in low- and middle-income countries. The aim of this study was to identify current challenges and describe the treatment and outcomes of Iranian pediatric patients with medulloblastoma who were referred to our center in Tehran, Iran. METHODS Our retrospective review included 126 patient records from April 2007 to May 2015. The records were analyzed for epidemiologic features, treatment modalities, overall survival, and progression-free survival. Data were analyzed using SPSS 22.0 software. RESULTS Median age at diagnosis was 6 years (male:female ratio, 2.3:1). At the time of diagnosis, 7 patients were 2 years or younger, and 76 (60.3%) were categorized as having high-risk disease. Overall, 100 patients had gross or near-total surgical resection. Cerebral spinal fluid involvement was detected in 22.2% of the patients tested, and spinal involvement was detected in 25% of the patients who underwent spinal MRI. Metastasis stages at the time of diagnosis were as follows: M0: 48.4% patients, M1: 16.7%, M2: 5.5%, and M3: 21.4%. Median times of follow-up and progression-free survival were 16 and 12 months, respectively. Probability of 7-year overall survival and progression-free survival were 59 and 53.8%, respectively. CONCLUSIONS Results of the current retrospective study emphasize the need for implementing measures to improve outcome for our patients with medulloblastoma. Such measures include a multidisciplinary approach, unified national treatment guidelines, better disease and metastasis staging, twinning initiatives, and seeking a second opinion when needed.
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Affiliation(s)
- Azim Mehrvar
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
- AJA University of Medical Sciences, Tehran, Iran
| | - Maryam Tashvighi
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
- Islamic Azad University of Medical Sciences, Qom, Iran
| | | | - Naghmeh Niktoreh-Mofrad
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran.
- Department of Pediatric Hematology and Oncology, University Children's Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Narjes Mehrvar
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negar Afsar
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Ali Naderi
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | | | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mohammad Faranoush
- MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
- Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
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Tashvighi M, Mehrvar A, Hedayati Asl AA, Mehrvar N, Ghorbani R, Naderi A, Alebouyeh M, Sattary E, Niktoreh Mofrad N, Qaddoumi I, Faranoush M. Treatment challenges and outcomes for pediatric intracranial ependymoma at a single institution in Iran. Pediatr Hematol Oncol 2018; 35:60-75. [PMID: 29565756 DOI: 10.1080/08880018.2018.1435758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The scarcity of information on pediatric ependymoma in Iran motivated this study. Our main objectives were to determine outcomes, identify clinical management challenges at a nongovernment hospital in Iran, and devise guidelines for improving care. PROCEDURE A retrospective chart review was performed for pediatric patients with ependymoma who were younger than 15 years and treated at MPCTRC between 2007 and 2015. Records included patient demographics, treatment regimens used, duration of follow-up, and outcomes. Clinical outcomes [ie, 3-year overall survival (OS) and progression-free survival (PFS)] were determined based on the age at diagnosis (younger or older than 3 years) by using the Kaplan-Meier method. RESULTS In total, 73 eligible patients were enrolled; 20 patients were in the younger group, and 53 were in the older group. The majority (91.8%, n = 67) of patients underwent initial gross-total or partial surgical resection, and 6 (8.2%) had a biopsy. Twenty-one patients experienced ependymoma recurrence. The median time to relapse was 1 year. The median duration of follow-up and PFS were 25 and 17 months, respectively. The 3-year OS and PFS were 61% and 59.5%, respectively. At the time of this project, 27 patients had died, and 35 were alive with no evidence of disease. CONCLUSION Our study demonstrated inferior outcomes of Iranian children with ependymoma. To improve our care for these children, a paradigm shift must occur that includes radiation therapy as standard of care, second-look surgery, a multidisciplinary team approach, and potentially twinning initiatives.
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Affiliation(s)
- Maryam Tashvighi
- a MAHAK Pediatric Cancer Treatment and Research Center , Tehran , Iran
| | - Azim Mehrvar
- a MAHAK Pediatric Cancer Treatment and Research Center , Tehran , Iran.,b AJA University of Medical Sciences , Tehran , Iran
| | | | - Narjes Mehrvar
- c Cancer Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Raheb Ghorbani
- d Social Determinants of Health Research Center , Semnan University of Medical Sciences , Semnan , Iran
| | - Ali Naderi
- a MAHAK Pediatric Cancer Treatment and Research Center , Tehran , Iran
| | | | - Erfan Sattary
- e Islamic Azad University of Medical Sciences (Ghom Branch) , Tehran , Iran
| | - Naghmeh Niktoreh Mofrad
- f Department of Pediatric Hematology and Oncology , University Children's Hospital Essen , Essen , Germany
| | - Ibrahim Qaddoumi
- g St. Jude Children's Research Hospital , Memphis , Tennessee , USA
| | - Mohammad Faranoush
- a MAHAK Pediatric Cancer Treatment and Research Center , Tehran , Iran.,h Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism , Iran University of Medical Sciences , Tehran , Iran
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Comprehensive analysis of Iranian reports of pediatric central nervous system tumors. Childs Nerv Syst 2017; 33:1481-1490. [PMID: 28555309 PMCID: PMC5708155 DOI: 10.1007/s00381-017-3468-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Iran lacks a national registry reporting the data of central nervous system (CNS) tumors in children. Consequently, treatment success and failure rates are unknown, and a centralized system for disease-management recommendations does not exist. METHODS To critically evaluate the current state of pediatric CNS tumor studies and reporting in Iran, we performed an extensive retrospective analysis of all known reports identified with multiple search engines. RESULTS Of 409 initially retrieved articles, we evaluated 123 matching our inclusion criteria. We further narrowed these reports to 74 by excluding studies pertaining to adult patients only, non-CNS tumors, or brain metastases. We also excluded studies that were performed outside of Iran or that did not contain relevant data from our analysis. We divided the remaining studies into those describing exclusively pediatric patients (3484 patients) and those describing mixed populations of adults and children (18,641 patients). In total, our analysis included 22,125 patients. CONCLUSIONS We identified many limitations in the reporting of studies describing the treatment or prevalence of CNS tumors in children in Iran. Our results may guide future efforts in Iran to improve the care for children with CNS tumors and may provide a valuable template for other comprehensive country- and disease-specific retrospective analyses.
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Pediatric brain tumors in a low/middle income country: does it differ from that in developed world? J Neurooncol 2015; 126:371-6. [DOI: 10.1007/s11060-015-1979-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/25/2015] [Indexed: 01/09/2023]
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Parkes J, Hendricks M, Ssenyonga P, Mugamba J, Molyneux E, Schouten-van Meeteren A, Qaddoumi I, Fieggen G, Luna-Fineman S, Howard S, Mitra D, Bouffet E, Davidson A, Bailey S. SIOP PODC adapted treatment recommendations for standard-risk medulloblastoma in low and middle income settings. Pediatr Blood Cancer 2015; 62:553-64. [PMID: 25418957 DOI: 10.1002/pbc.25313] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/16/2014] [Indexed: 01/11/2023]
Abstract
Effective treatment of children with medulloblastoma requires a functioning multi-disciplinary team with adequate neurosurgical, neuroradiological, pathological, radiotherapy and chemotherapy facilities and personnel. In addition the treating centre should have the capacity to effectively screen and manage any tumour and treatment-associated complications. These requirements have made it difficult for many low and middle-income countries (LMIC) centres to offer curative treatment. This article provides management recommendations for children with standard-risk medulloblastoma (localised tumours in children over the age of 3-5 years) according to the level of facilities available.
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Affiliation(s)
- Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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