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Khan MS, Maaz AUR, Qazi AQ, Aslam S, Riaz S, Malik AS, Shaheen N. Prognostic impact of pre-referral tumor resection in unilateral Wilms tumor: A single-institute experience from a lower middle-income country. Pediatr Blood Cancer 2024; 71:e30760. [PMID: 37962283 DOI: 10.1002/pbc.30760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/09/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The objectives of this study were to evaluate the prognostic impact of pre-referral surgical resection of Wilms tumor (WT) performed at non-oncology centers, and to strategize an improved care plan for this very curable pediatric tumor. METHODS In this study conducted in a large pediatric cancer center in Pakistan, we retrospectively reviewed the electronic medical records (EMR) of 149 patients with unilateral WT from September 2008 to August 2017. Based on treatment approach, patients were categorized into two groups: (i) pre-referral tumor resection (PTR: n = 75), and (ii) post-neoadjuvant chemo nephrectomy (PCN: n = 74). RESULTS The proportion of metastatic disease in PTR and PCN groups was 33.3% and 35.1%, respectively. In the PTR subset, median time to admission after PTR was 5 weeks (mean 11, SEM 2.8, range: 2-202) weeks, with 53.3% (n = 40) presenting more than 4 weeks after PTR. Twenty patients had no cross-sectional imaging prior to PTR and underwent surgery after abdominal ultrasound only. On baseline imaging at our center, 58.7% (n = 44) of the PTR group had radiologically evaluable disease (four metastases only, 19 local residual tumor only, 21 both localized tumor and visible metastases). Disease staging was uncertain in 23 patients because of no or inadequate histology specimens and/or lymph node sampling in patients with no evaluable disease. Statistically significant differences were recorded for the two subsets regarding tumor volume, extent and nodularity, renal vein and renal sinus involvement, lymph node status, tumor rupture and histopathologic features, and tumor stage, with a 10-year event-free survival (EFS) for PCN and PTR of 74.3% and 50.7%, respectively (p < .001). In the PTR group, EFS for those presenting within 4 weeks and later was 91.4% versus 15.0%, respectively (p < .0001). CONCLUSION Suboptimal pre-referral surgical intervention results in poor survival outcomes in unilateral WT. Our findings highlight the need for a comprehensive action plan for educating healthcare professionals engaged in WT diagnosis and referral process. PCN in a multidisciplinary team approach can reduce surgical morbidity and seems to be a better strategy to improve the survival rates in low-resource settings.
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Affiliation(s)
- Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah Al Munawarrah, Saudi Arabia
| | - Ata Ur Rehman Maaz
- Division of Hematology/Oncology, Child Health, Sidra Medicine, Doha, Qatar
| | - Abid Quddus Qazi
- Pediatric Surgeon, Al Jalila Children's Specialty Hospital Dubai, Dubai, United Arab Emirates
| | - Sophia Aslam
- Pediatric Oncology Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Shazia Riaz
- Department of Pediatric Hematology/Oncology, The Children's Hospital and Institute of Child Health Lahore, Lahore, Pakistan
| | - Ayesha Saeed Malik
- Department of Pediatrics, King Edward Medical University, Lahore, Pakistan
| | - Najma Shaheen
- Department of Pediatric Oncology, Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
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2
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Lemmen J, Njuguna F, Verhulst S, Vik TA, Ket JCF, Kaspers G, Mostert S. Late Effects of Childhood Cancer Survivors in Africa: a Scoping Review. Crit Rev Oncol Hematol 2023; 185:103981. [PMID: 37003444 DOI: 10.1016/j.critrevonc.2023.103981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION The number of children surviving cancer in Africa is increasing. Knowledge about late effects of survivors is lacking. Our study maps literature regarding late effects of childhood cancer survivors in Africa. METHODS Scoping review was performed following JBI-guidelines. Systematic literature search was conducted in: Medline, Embase, African Index Medicus, Web of Science, Scopus, Psycinfo. Titles and abstracts were screened by two reviewers, followed by full-text analysis by the lead reviewer. RESULTS Sixty-eight studies were included for content analysis. Studies originated from 10 of 54 African countries. Most studies had retrospective study design, 2-5 years follow-up, solely chemotherapy as treatment modality, Egypt as country of origin. Fifty-three studies described physical, and seventeen studies described psychosocial late effects. CONCLUSION Literature concerning late effects is available from a limited number of African countries. Psychosocial domain lacks attention compared to the physical domain. More countries should report on this topic to prevent, identify and monitor late effects.
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Affiliation(s)
- Jesse Lemmen
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands; Princess Máxima Center for Pediatric oncology, Utrecht, the Netherlands.
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi Teaching and Referral Hospital, Moi University, Eldoret, Kenya
| | - Sanne Verhulst
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands
| | - Terry A Vik
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, United States of America
| | | | - Gertjan Kaspers
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands; Princess Máxima Center for Pediatric oncology, Utrecht, the Netherlands
| | - Saskia Mostert
- Emma's Children Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Pediatric oncology, the Netherlands; Princess Máxima Center for Pediatric oncology, Utrecht, the Netherlands
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3
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Uittenboogaard A, Njuguna F, Mostert S, Langat S, van de Velde ME, Olbara G, Vik TA, Kaspers GJL. Outcomes of Wilms tumor treatment in western Kenya. Pediatr Blood Cancer 2022; 69:e29503. [PMID: 34908225 DOI: 10.1002/pbc.29503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND/OBJECTIVES Wilms tumor (WT) is a curable type of cancer with 5-year survival rates of over 90% in high-income countries, whereas this is less than 50% in low- and middle-income countries. We assessed treatment outcomes of children with WT treated at a large Kenyan teaching and referral hospital. DESIGN/METHODS We conducted a retrospective record review of children diagnosed with WT between 2013 and 2016. Treatment protocol consisted of 6 weeks of preoperative chemotherapy and surgery, and 4-18 weeks of postoperative chemotherapy depending on disease stage. Probability of event-free survival (pEFS) and overall survival (pOS) was assessed using Kaplan-Meier method with Cox regression analysis. Competing events were analyzed with cumulative incidences and Fine-Gray regression analysis. RESULTS Of the 92 diagnosed patients, 69% presented with high-stage disease. Two-year observed EFS and OS were, respectively, 43.5% and 67%. Twenty-seven percent of children died, 19% abandoned treatment, and 11% suffered from progressive or relapsed disease. Patients who were diagnosed in 2015-2016 compared to 2013-2014 showed higher pEFS. They less often had progressive or relapsed disease (p = .015) and borderline significant less often abandonment of treatment (p = .09). Twenty-nine children received radiotherapy, and 2-year pEFS in this group was 86%. CONCLUSION Outcome of children with WT improved over the years despite advanced stage at presentation. Survival probabilities of patients receiving comprehensive therapy including radiation are approaching those of patients in high-income countries. Additional improvement could be achieved by ensuring that patients receive all required treatment and working on earlier diagnosis strategies.
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Affiliation(s)
- Aniek Uittenboogaard
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Academy and Outreach, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Saskia Mostert
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Academy and Outreach, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sandra Langat
- Department of Child Health and Pediatrics, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Mirjam E van de Velde
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gilbert Olbara
- Department of Child Health and Pediatrics, Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Terry A Vik
- Pediatric Hematology - Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gertjan J L Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Academy and Outreach, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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4
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Major A, Palese M, Ermis E, James A, Villarroel M, Klussmann FA, Hessissen L, Geel J, Khan MS, Dalvi R, Sullivan M, Kearns P, Frazier AL, Pritchard-Jones K, Nakagawara A, Rodriguez-Galindo C, Volchenboum SL. Mapping Pediatric Oncology Clinical Trial Collaborative Groups on the Global Stage. JCO Glob Oncol 2022; 8:e2100266. [PMID: 35157510 PMCID: PMC8853619 DOI: 10.1200/go.21.00266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The global pediatric oncology clinical research landscape, particularly in Central and South America, Africa, and Asia, which bear the highest burden of global childhood cancer cases, is less characterized in the literature. Review of how existing pediatric cancer clinical trial groups internationally have been formed and how their research goals have been pursued is critical for building global collaborative research and data-sharing efforts, in line with the WHO Global Initiative for Childhood Cancer. Local stakeholder engagement is necessary to collaborate with global pediatric cancer trial groups.![]()
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Affiliation(s)
- Ajay Major
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Monica Palese
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Ebru Ermis
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Anthony James
- Department of Pediatrics, University of Chicago, Chicago, IL
| | - Milena Villarroel
- Grupo de América Latina de Oncología Pediátrica (GALOP), Hospital Luis Calvo Mackenna, National Pediatric Cancer Program (PINDA), Santiago, Chile
| | - Federico Antillon Klussmann
- National Unit of Pediatric Oncology, Francisco Marroquin University School of Medicine, Guatemala City, Guatemala
| | - Laila Hessissen
- Pediatric Hematology and Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | - Jennifer Geel
- Faculty of Health Sciences, Division of Pediatric Haematology and Oncology, Department of Pediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah, Saudi Arabia
| | - Rashmi Dalvi
- Bombay Hospital Institute of Medical Sciences and SRCC Children's Hospital, Mumbai, India
| | - Michael Sullivan
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, Birmingham, United Kingdom
| | | | - Kathy Pritchard-Jones
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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Biondi A, Conter V, Chandy M, Ewald P, Lucia de Martino Lee M, Radhakrishnan VS, Rotchanapanya W, Scanlan P, Patrick Smith O, Togo B, Hokland P. Precursor B-cell acute lymphoblastic leukaemia-a global view. Br J Haematol 2021; 196:530-547. [PMID: 34931311 PMCID: PMC9300129 DOI: 10.1111/bjh.17959] [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: 08/31/2021] [Revised: 10/28/2021] [Accepted: 10/31/2021] [Indexed: 12/30/2022]
Abstract
As haematologists, we always seek to follow standardised guidelines for practice and apply the best treatment within our means for our patients with blood diseases. However, treatment can never follow an exact recipe. Opinions differ as to the best approach; sometimes more than one treatment approach results in identical outcomes, or treatments differ only by the manner in which they fail. Furthermore, the haematologist is faced with constraints relating to the local economic environment. Patients too are not the same the world over. Early presentation is commoner in the developed world, as is the patient’s understanding of the disease process. This in turn has an impact on the way patients are managed, the rigorousness of patient adhesion to the treatment schedule and the outcome. Here we take a look at the precursor B‐cell acute lymphoblastic leukaemia in an adolescent in a range of different settings from low‐ to high income countries with widely differing challenges for diagnosis, therpy and follow‐up. For these reasons, given the same starting conditions, patients will be treated differently according to the institute and the country they are in. Experts from around the world have been tasked to describe their management plan and rationale for a specific disease presentation. Here they explore the management of precursor B‐cell acute lymphoblastic leukaemia (pre‐B ALL) in five different institutions worldwide with a focus on those with more or less strained economies. We end with a conclusion from an expert in the field comparing and contrasting these different management styles and considering their merits and limitations.
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Affiliation(s)
- Andrea Biondi
- Clinica Pediatrica, Fondazione MBBM, Università Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Valentino Conter
- Clinica Pediatrica, Fondazione MBBM, Università Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Mammen Chandy
- Department of Clinical Haematology Oncology and HCT, Tata Medical Center, Kolkata, India
| | - Primus Ewald
- Muhimbili National Hospital and Tumaini la Maisha Children's Cancer Charity, Dar es Salaam, Tanzania
| | | | - Vivek S Radhakrishnan
- Department of Clinical Haematology Oncology and HCT, Tata Medical Center, Kolkata, India
| | - Wannaphorn Rotchanapanya
- Division of Hematology, Department of Medicine, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Patricia Scanlan
- Muhimbili National Hospital and Tumaini la Maisha Children's Cancer Charity, Dar es Salaam, Tanzania
| | - Owen Patrick Smith
- Department of Paediatric and Adolescent Medicine, University College Dublin, Dublin, Ireland
| | - Boubacar Togo
- Department of Pediatrics, CHU Gabriel Touré, Bamako, Mali
| | - Peter Hokland
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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6
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Chagaluka G, Afungchwi GM, Landman L, Njuguna F, Hesseling P, Tchintseme F, Sung L, Paintsil V, Molyneux E, Chitsike I, Israels T. Treatment abandonment: A report from the collaborative African network for childhood cancer care and research-CANCaRe Africa. Pediatr Blood Cancer 2021; 68:e29367. [PMID: 34549506 DOI: 10.1002/pbc.29367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND 'Treatmentabandonment' is a common and preventable cause of childhood cancer treatment failure in low- and middle-income countries (LMIC). Risk factors and effective interventions in LMIC are reported. Poverty and costs of treatment are perceived as overriding causes in sub-Saharan Africa. The objective of this study was to study potential determinants of treatment abandonment, including aspects of treatment costs in sub-Saharan Africa, to be better informed for planned future interventions. METHODS A multicentre, prospective, observational, cohort study was conducted in five hospitals in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated as inpatient with curative intent were included. The occurrence of treatment abandonment and potential determinants including aspects of treatment costs were documented during the first 3 months of treatment. RESULTS We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Seven percent of patients (18 of 252) abandoned treatment. Two thirds (65%, 163/252) of patients had to borrow money to reach the hospital for the diagnosis and start of treatment. Treatment abandonment occurred more frequently in families who had to borrow money (16/163, 10%) versus those who did not (2/89, 2%; p = .026). CONCLUSIONS Limiting costs for families and improved counselling may reduce treatment abandonment. Development and implementation of interventions to reduce treatment abandonment are required in sub-Saharan Africa.
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Affiliation(s)
- George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Glenn Mbah Afungchwi
- Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mbingo, Cameroon
| | - Lisa Landman
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Moi University/Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Tchintseme
- Cameroon Baptist Convention Hospitals in Mutengene, Mbingo and Banso, Mbingo, Cameroon
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | | | - Trijn Israels
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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7
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Geel JA, Ranasinghe N, Myezo KH, Davidson A, Howard SC, Hessissen L, Bouffet E, Challinor J. Pediatric cancer care in Africa: SIOP Global Mapping process. Pediatr Blood Cancer 2021; 68:e29315. [PMID: 34455693 DOI: 10.1002/pbc.29315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 07/24/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022]
Abstract
In November 2018, theInternational Society of Paediatric Oncology (SIOP) launched a project to map African facilities providing pediatric oncology treatment. A 55-item digital survey was created in English, piloted in India, translated to French and Portuguese, and distributed by email, social media, or personal contacts. December 2019, 48/54 African countries responded (72% surveys completed and analyzed). Issues included incomplete responses, multiple entries for one facility with conflicting data for key services, and repeated entries with varied answers by the same respondent. The facility mapping project, now on-going program will serve as a global registry of global pediatric cancer centers.
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Affiliation(s)
- Jennifer Ann Geel
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Neil Ranasinghe
- SIOP PODC Education and Training Working Group, Refinitiv, London, UK
| | - Khumo Hope Myezo
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Alan Davidson
- Division of Paediatric Haematology/Oncology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Scott C Howard
- Department of Acute and Tertiary Care, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Resonance, Arlington, Tennessee, USA
| | - Laila Hessissen
- Paediatric Hematology and Oncology Unit of Rabat, Mohamed V University, Rabat, Morocco
| | - Eric Bouffet
- Garron Chair in Childhood Cancer Research, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Challinor
- School of Nursing, University of California San Francisco, San Francisco, California, USA
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8
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Spreafico F, Fernandez CV, Brok J, Nakata K, Vujanic G, Geller JI, Gessler M, Maschietto M, Behjati S, Polanco A, Paintsil V, Luna-Fineman S, Pritchard-Jones K. Wilms tumour. Nat Rev Dis Primers 2021; 7:75. [PMID: 34650095 DOI: 10.1038/s41572-021-00308-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 02/08/2023]
Abstract
Wilms tumour (WT) is a childhood embryonal tumour that is paradigmatic of the intersection between disrupted organogenesis and tumorigenesis. Many WT genes play a critical (non-redundant) role in early nephrogenesis. Improving patient outcomes requires advances in understanding and targeting of the multiple genes and cellular control pathways now identified as active in WT development. Decades of clinical and basic research have helped to gradually optimize clinical care. Curative therapy is achievable in 90% of affected children, even those with disseminated disease, yet survival disparities within and between countries exist and deserve commitment to change. Updated epidemiological studies have also provided novel insights into global incidence variations. Introduction of biology-driven approaches to risk stratification and new drug development has been slower in WT than in other childhood tumours. Current prognostic classification for children with WT is grounded in clinical and pathological findings and in dedicated protocols on molecular alterations. Treatment includes conventional cytotoxic chemotherapy and surgery, and radiation therapy in some cases. Advanced imaging to capture tumour composition, optimizing irradiation techniques to reduce target volumes, and evaluation of newer surgical procedures are key areas for future research.
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Affiliation(s)
- Filippo Spreafico
- Department of Medical Oncology and Hematology, Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Conrad V Fernandez
- Department of Paediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jesper Brok
- Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - James I Geller
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Cincinnati, OH, USA
| | - Manfred Gessler
- Theodor-Boveri-Institute, Developmental Biochemistry, and Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg, Germany
| | - Mariana Maschietto
- Research Center, Boldrini Children's Hospital, Genetics and Molecular Biology, Institute of Biology, State University of Campinas, Campinas, SP, Brazil
| | - Sam Behjati
- Wellcome Sanger Institute, Hinxton, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Angela Polanco
- National Cancer Research Institute Children's Group Consumer Representative, London, UK
| | - Vivian Paintsil
- Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sandra Luna-Fineman
- Division of Hematology, Oncology and Bone Marrow Transplantation, Department of Paediatrics, University of Colorado, Aurora, CO, USA
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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9
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Israels T, Afungchwi GM, Chagaluka G, Hesseling P, Kouya F, Paintsil V, Landman L, Chitsike I, Njuguna F, Sung L, Molyneux E. Early death and treatment-related mortality: A report from SUCCOUR - Supportive Care for Children with Cancer in Africa. Pediatr Blood Cancer 2021; 68:e29230. [PMID: 34245228 DOI: 10.1002/pbc.29230] [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: 04/02/2021] [Revised: 05/18/2021] [Accepted: 06/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Deaths during paediatric cancer treatment are common in Africa. It is often difficult to distinguish between treatment-related and disease-related causes. To prevent these deaths, it is important to study them and identify the cause. The Supportive Care for Children with Cancer in Africa (SUCCOUR) programme enabled a study with the objective to identify the reasons for early death during treatment. METHODS We conducted a multicentre prospective, observational cohort study in sub-Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated with curative intent were included from 1 September 2019 until 30 March 2020. Data were abstracted in real time by trained personnel using standardised case report forms. The treating clinician's assessment of the cause of death and signs, symptoms and laboratory values of patients who died during the first 3 months of treatment (early death) were documented. RESULTS We included 252 patients (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Fifteen percent of patients (37/252) died during the first 3 months of treatment. Of these 37 patients, 33 (89%) died of a treatment-related cause. Treatment-related mortality of all patients in the first 3 months of treatment was 13% (33/252). CONCLUSION Fifteen percent of patients had an early death during treatment and 13% had a treatment-related death. This suggests the need to improve supportive care. Implementation of supportive care pathways adapted to local circumstances may be helpful.
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Affiliation(s)
- Trijn Israels
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.,Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | | | - George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Kouya
- Cameroon Baptist Convention Hospitals, Mutengene, Cameroon
| | - Vivian Paintsil
- Department of Child Health, Kumasi School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lisa Landman
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Inam Chitsike
- Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
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10
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Harif M, Mallon B, Patte C, Bey P, Chalvon-Demersay C, Omer-Decugis L, Hessissen L. Improving Care for Children With Cancer in Africa: Two Decades of Experience of the French African Pediatric Oncology Group. JCO Glob Oncol 2021; 7:1509-1512. [PMID: 34678073 PMCID: PMC8547926 DOI: 10.1200/go.21.00239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/26/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Mhamed Harif
- Groupe Franco-Africain d’Oncologie Pédiatrique, Centre Hospitalier Universitaire Tanger, Faculté de médecine et de pharmacie, Casablanca, Morocco
| | - Brenda Mallon
- Groupe Franco-Africain d’Oncologie Pédiatrique, Villejuif, France
| | - Catherine Patte
- Groupe Franco-Africain d’Oncologie Pédiatrique, Villejuif, France
| | - Pierre Bey
- Groupe Franco-Africain d’Oncologie Pédiatrique, Villejuif, France
| | | | | | - Laila Hessissen
- Groupe Franco-Africain d’Oncologie Pédiatrifque, Centre Hospitalier Ibn Sina, Faculté de Médecine et de pharmacie, Rabat, Morocco
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Israels T, Afungchwi GM, Klootwijk L, Njuguna F, Hesseling P, Kouya F, Paintsil V, Landman L, Chitsike I, Chagaluka G, Sung L, Molyneux E. Fever and neutropenia outcomes and areas for intervention: A report from SUCCOUR - Supportive Care for Children with Cancer in Africa. Pediatr Blood Cancer 2021; 68:e29224. [PMID: 34245212 DOI: 10.1002/pbc.29224] [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: 03/29/2021] [Revised: 05/18/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Death during paediatric cancer treatment is common in sub-Saharan Africa. Using the infrastructure of Supportive Care for Children with Cancer in Africa (SUCCOUR), our objective was to describe fever and neutropenia (FN) characteristics and outcomes in order to identify potential areas for future intervention. METHODS A multicentre prospective, observational cohort study was conducted in sub-Saharan Africa. Data were collected from September 2019 to March 2020. Children below 16 years with newly diagnosed cancer treated with curative intent were included. Data were abstracted in real time using standardised case report forms by trained personnel. Characteristics and outcomes of FN during the first 3 months of treatment were documented. RESULTS A total of 252 patients were included (median age 6.0, range 0.2-15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Among 104 FN episodes, 21 (21%) were associated with prolonged neutropenia (>1 week) and 32 (31%) were associated with profound neutropenia (absolute neutrophil count <0.1 × 109 /L). In 10/104 (10%) episodes, empiric antibiotics were started within 1 hour following fever onset and in 16/104 (15%) episodes, a blood culture was obtained before starting antibiotics. Malaria parasitaemia was detected in four of 104 (4%). A total of 11/104 (11%) patients died in the FN episodes. CONCLUSIONS Although in most, FN was not associated with prolonged or profound neutropenia, 11% resulted in death. Areas to target include blood cultures prior to antibiotics and earlier initiation of empiric antibiotics. Future efforts should modify FN practices to reduce treatment-related mortality.
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Affiliation(s)
- Trijn Israels
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Larissa Klootwijk
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Peter Hesseling
- Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Francine Kouya
- Cameroon Baptist Convention Hospitals, Mutengene, Cameroon
| | - Vivian Paintsil
- Department of Child Health, Kumasi School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lisa Landman
- Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands
| | - Inam Chitsike
- Department of Paediatrics and Child Health, University of Zimbabwe, Harare, Zimbabwe
| | - George Chagaluka
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
| | - Lillian Sung
- Division of Haematology/Oncology and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Molyneux
- Queen Elizabeth Central Hospital (QECH), College of Medicine, Blantyre, Malawi
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Schüz J, Roman E. Childhood cancer: A global perspective. Cancer Epidemiol 2021; 71:101878. [PMID: 33358343 DOI: 10.1016/j.canep.2020.101878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Lyon, France.
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, United Kingdom
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