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Nasir AA, Abdur-Raheem NT, Abdur-Rahman LO, Ibiyeye TT, Sayomi TO, Adedoyin OT, Adeniran JO. Characteristics and Clinical Outcomes of Children With Wilms' Tumour: A 15-year Experience in a Single Centre in Nigeria. J Pediatr Surg 2024; 59:1009-1014. [PMID: 38184433 DOI: 10.1016/j.jpedsurg.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Wilms' tumor (WT) is the most common paediatric renal tumor and is one of the most treatment-responsive solid tumours. Survival from Wilms tumour (WT) in sub-Saharan Africa remains dismal as a result of late presentation, treatment abandonment and infrastructure deficit. The purpose of this study was to analyze the clinical outcome of children with Wilms tumour managed in a Nigerian referral centre over a 15-year period. METHODS This is a retrospective study of children with WT (nephroblastoma) who were treated at our institution between January 2006 and December 2020. Clinical characteristics, treatments, and outcomes were analyzed. RESULTS Thirty-five patients were identified. The median age at diagnosis was 36 months including 22 (62.9 %) females. Twenty-six (74.3 %) had advanced (stage III & IV) disease. Confirmatory histology was available for 16 patients ((45.7 %) among which 10 (62.5 %) were mixed type. The right kidney was affected in 18 patients (51.4 %), left in 15 (42.9 %) and 2 were not documented. Preoperative chemotherapy was given in 22 (62.9 %) patients and 13 (37.1) patients had primary nephrectomy. Eight (22.9 %) patients died during treatment (from disease or treatment related causes), and one abandoned treatment. A total of 26 patients completed treatment. Out of these, 8 (30.8 %) were lost to follow up, four patients died and 14 (53.8 %) patients survived at a median follow-up period of 18 months. The survival decreased with advancing stages of the disease, p = 0.002. CONCLUSIONS Majority of children with Wilms tumour in our practice presented with advanced disease. Death during treatment, treatment abandonment and lost to follow up were common. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Retrospective Study.
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Affiliation(s)
- Abdulrasheed A Nasir
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria.
| | - Nurudeen T Abdur-Raheem
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lukman O Abdur-Rahman
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Tolulope O Sayomi
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olanrewaju T Adedoyin
- Division of Nephrology, Department of Paediatric, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - James O Adeniran
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
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2
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Sepenu P, Swarray-Deen A, Scott A, Boafor TK, Baah WK, Kyei MK, Coleman J. Disseminated adult Wilms tumor in pregnancy: Leveraging multidisciplinary care in a low-resource setting. Int J Gynaecol Obstet 2024; 165:601-606. [PMID: 37731328 DOI: 10.1002/ijgo.15157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/27/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023]
Abstract
Wilms tumor (WT) occurring in adults is rare and even much more rarely found to coexist with pregnancy. Clinical outcome in adults is worse overall compared with pediatric patients with WT and is often misdiagnosed with no standardized protocols for care guided by high-evidence clinical trials. We present a case of a 23-year-old woman diagnosed with WT who was found to be pregnant immediately following nephrectomy. Workup findings showed that she had disseminated disease but was successfully managed in a multidisciplinary team setting with modified intrapartum chemotherapy followed by postpartum chemotherapy. In low-resource settings, management protocols for adult patients with WT can be individualized by multidisciplinary teams to leverage available resources for best outcomes.
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Affiliation(s)
- Perez Sepenu
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Alim Swarray-Deen
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Aba Scott
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Theodore K Boafor
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Winfred K Baah
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Mathew K Kyei
- Department of Surgery, Urology Unit, University of Ghana Medical School, Accra, Ghana
| | - Jerry Coleman
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
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3
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Majaliwa E, Smith ER, Cotache-Condor C, Rice H, Gwanika Y, Canick J, Chao N, Schroeder K, Rice HE, Staton C, Mmbaga BT. Childhood and Adolescent Cancer Care at a Tertiary Hospital in Northern Tanzania: A Retrospective Study. JCO Glob Oncol 2023; 9:e2200263. [PMID: 37384861 PMCID: PMC10497254 DOI: 10.1200/go.22.00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE Over 400,000 children are diagnosed with cancer around the world each year, with over 80% of these children residing in low- and middle-income countries. This study aims to summarize the epidemiology and care patterns of newly diagnosed childhood cancer patients in Northern Tanzania. METHODS Data from all children and adolescents (age 0-19 years) with newly diagnosed cancers were collected from the Kilimanjaro Cancer Registry located at the Kilimanjaro Christian Medical Centre. Descriptive and inferential analyses were used to compare the demographic and clinical characteristics of the participants over time, stage, and status at last contact. Statistical significance was set at P < .05. Secondary descriptive analysis was conducted on a subset sample with available staging data. RESULTS A total of 417 patients were diagnosed with cancer between 2016 and 2021. There was an increase in the rate of patients with newly diagnosed pediatric cancer each year, particularly among children under age 5 years and 10 years. Leukemias and lymphomas were the leading diagnoses and accounted for 183 (43.8%) of all patients. Over 75% of patients were diagnosed at stage III or above. From a subset analysis of patients with available staging data (n = 101), chemotherapy was the most common treatment (87.1%), compared with radiotherapy and surgery. CONCLUSION There is a significant burden of children with cancer in Tanzania. Our study fills crucial gaps in the literature related to the large burden of disease and survival for children with cancer in the Kilimanjaro region. Furthermore, our results can be used to understand the regional needs and guide research and strategic interventions to improve childhood cancer survival in Northern Tanzania.
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Affiliation(s)
- Esther Majaliwa
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Emily R. Smith
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hannah Rice
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yotham Gwanika
- Kilimanjaro Cancer Registry, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Julia Canick
- Duke Global Health Institute, Duke University, Durham, NC
| | - Nelson Chao
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Kristin Schroeder
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Catherine Staton
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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4
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Ortiz MV, Koenig C, Armstrong AE, Brok J, de Camargo B, Mavinkurve-Groothuis AMC, Herrera TBV, Venkatramani R, Woods AD, Dome JS, Spreafico F. Advances in the clinical management of high-risk Wilms tumors. Pediatr Blood Cancer 2023; 70 Suppl 2:e30342. [PMID: 37096797 PMCID: PMC10857813 DOI: 10.1002/pbc.30342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/24/2022] [Indexed: 04/26/2023]
Abstract
Outcomes are excellent for the majority of patients with Wilms tumors (WT). However, there remain WT subgroups for which the survival rate is approximately 50% or lower. Acknowledging that the composition of this high-risk group has changed over time reflecting improvements in therapy, we introduce the authors' view of the historical and current approach to the classification and treatment of high-risk WT. For this review, we consider high-risk WT to include patients with newly diagnosed metastatic blastemal-type or diffuse anaplastic histology, those who relapse after having been initially treated with three or more different chemotherapeutics, or those who relapse more than once. In certain low- or low middle-income settings, socio-economic factors expand the definition of what constitutes a high-risk WT. As conventional therapies are inadequate to cure the majority of high-risk WT patients, advancement of laboratory and early-phase clinical investigations to identify active agents is urgently needed.
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Affiliation(s)
- Michael V Ortiz
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christa Koenig
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Amy E Armstrong
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jesper Brok
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Pediatric Oncology and Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | | | | | - Rajkumar Venkatramani
- Department of Pediatrics, Division of Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew D Woods
- Children's Cancer Therapy Development Institute, Beaverton, Oregon, USA
| | - Jeffrey S Dome
- Division of Oncology, Children's National Hospital and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Filippo Spreafico
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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5
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Holmes DM, Matatiyo A, Mpasa A, Huibers MHW, Manda G, Tomoka T, Mulenga M, Namazzi R, Mehta P, Zobeck M, Mzikamanda R, Chintagumpala M, Allen C, Nuchtern JG, Borgstein E, Aronson DC, Ozuah N, Nandi B, McAtee CL. Outcomes of Wilms tumor therapy in Lilongwe, Malawi, 2016-2021: Successes and ongoing research priorities. Pediatr Blood Cancer 2023; 70:e30242. [PMID: 36798020 PMCID: PMC10698850 DOI: 10.1002/pbc.30242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
INTRODUCTION Wilms tumor therapy in low- and middle-income countries (LMICs) relies on treatment protocols adapted to resource limitations, but these protocols have rarely been evaluated in real-world settings. Such evaluations are necessary to identify high-impact research priorities for clinical and implementation trials in LMICs. The purpose of this study was to identify highest priority targets for future clinical and implementation trials in sub-Saharan Africa by assessing outcomes of a resource-adapted treatment protocol in Malawi. METHODS We conducted a retrospective cohort study of children treated for Wilms tumor with an adapted SIOP-backbone protocol in Lilongwe, Malawi between 2016 and 2021. Survival analysis assessed variables associated with poor outcome with high potential for future research and intervention. RESULTS We identified 136 patients, most commonly with stage III (n = 35; 25.7%) or IV disease (n = 35; 25.7%). Two-year event-free survival (EFS) was 54% for stage I/II, 51% for stage III, and 13% for stage IV. A single patient with stage V disease survived to 1 year. Treatment abandonment occurred in 36 (26.5%) patients. Radiotherapy was indicated for 55 (40.4%), among whom three received it. Of these 55 patients, 2-year EFS was 31%. Of 14 patients with persistent metastatic pulmonary disease at the time of nephrectomy, none survived to 2 years. Notable variables independently associated with survival were severe acute malnutrition (hazard ratio [HR]: 1.9), increasing tumor stage (HR: 1.5), and vena cava involvement (HR: 3.1). CONCLUSION High-impact targets for clinical and implementation trials in low-resource settings include treatment abandonment, late presentation, and approaches optimized for healthcare systems with persistently unavailable radiotherapy.
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Affiliation(s)
- David M Holmes
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Apatsa Matatiyo
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Atupele Mpasa
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
| | - Minke H W Huibers
- Department of Outreach, Princess Maxima Center, Utrecht, Netherlands
| | - Geoffrey Manda
- Global Health Institute, Department of Epidemiology and Social Medicine, University of Antwerp, Belgium
| | - Tamiwe Tomoka
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Maurice Mulenga
- Department of Pathology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Ruth Namazzi
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Parth Mehta
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Mark Zobeck
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Rizine Mzikamanda
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Carl Allen
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jed G Nuchtern
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Eric Borgstein
- Department of Surgery, University of Malawi College of Medicine, Zomba, Malawi
| | - Daniel C Aronson
- Department of Surgery, University Children's Hospital Zürich, Zürich, Switzerland
| | - Nmazuo Ozuah
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bip Nandi
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Casey L McAtee
- Global Hematology-Oncology pediatric Excellence (HOPE), Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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6
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Cotache-Condor C, Kantety V, Grimm A, Williamson J, Landrum KR, Schroeder K, Staton C, Majaliwa E, Tang S, Rice HE, Smith ER. Determinants of delayed childhood cancer care in low- and middle-income countries: A systematic review. Pediatr Blood Cancer 2023; 70:e30175. [PMID: 36579761 DOI: 10.1002/pbc.30175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/30/2022]
Abstract
Early access to care is essential to improve survival rates for childhood cancer. This study evaluates the determinants of delays in childhood cancer care in low- and middle-income countries (LMICs) through a systematic review of the literature. We proposed a novel Three-Delay framework specific to childhood cancer in LMICs by summarizing 43 determinants and 24 risk factors of delayed cancer care from 95 studies. Traditional medicine, household income, lack of transportation, rural population, parental education, and travel distance influenced most domains of our framework. Our novel framework can be used as a policy tool toward improving cancer care and outcomes for children in LMICs.
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Affiliation(s)
| | - Vinootna Kantety
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Andie Grimm
- Birmingham's Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama, USA
| | | | - Kelsey R Landrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin Schroeder
- Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
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7
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Ortiz MV, Koenig C, Armstrong AE, Brok J, de Camargo B, Mavinkurve-Groothuis AMC, Herrera TBV, Venkatramani R, Woods AD, Dome JS, Spreafico F. Advances in the clinical management of high-risk Wilms tumors. Pediatr Blood Cancer 2023; 70:e30153. [PMID: 36625399 DOI: 10.1002/pbc.30153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
Outcomes are excellent for the majority of patients with Wilms tumors (WT). However, there remain WT subgroups for which the survival rate is approximately 50% or lower. Acknowledging that the composition of this high-risk group has changed over time reflecting improvements in therapy, we introduce the authors' view of the historical and current approach to the classification and treatment of high-risk WT. For this review, we consider high-risk WT to include patients with newly diagnosed metastatic blastemal-type or diffuse anaplastic histology, those who relapse after having been initially treated with three or more different chemotherapeutics, or those who relapse more than once. In certain low- or low middle-income settings, socio-economic factors expand the definition of what constitutes a high-risk WT. As conventional therapies are inadequate to cure the majority of high-risk WT patients, advancement of laboratory and early-phase clinical investigations to identify active agents is urgently needed.
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Affiliation(s)
- Michael V Ortiz
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christa Koenig
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Amy E Armstrong
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jesper Brok
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK.,Department of Pediatric Oncology and Hematology, Rigshospitalet, Copenhagen, Denmark
| | - Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Cancer, Rio de Janeiro, Brazil
| | | | | | - Rajkumar Venkatramani
- Department of Pediatrics, Division of Hematology/Oncology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew D Woods
- Children's Cancer Therapy Development Institute, Beaverton, Oregon, USA
| | - Jeffrey S Dome
- Division of Oncology, Children's National Hospital and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Filippo Spreafico
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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8
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Cotache-Condor C, Grimm A, Williamson J, Kantety V, Landrum K, Schroeder K, Staton CA, Majaliwa E, Rice HE, Smith ER. Factors contributing to delayed childhood cancer care in low- and middle-income countries: A systematic review protocol. Pediatr Blood Cancer 2022; 69:e29646. [PMID: 35253351 DOI: 10.1002/pbc.29646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Significant disparities exist for timely access to cancer care for children, with the highest disparities in low- and middle-income countries (LMICs). This study aims to conduct a systematic review that identifies the factors contributing to delayed care of childhood cancers in LMICs. METHODS We will conduct a systematic review with search strings compliant with the PICO framework: (1) the Population-children (aged 0-18 years) from LMICs; (2) the Exposure-factors contributing to timely childhood cancer care; (3) the Outcome-delays in childhood cancer care. DISCUSSION Our study is an essential step to guide strategic interventions to assess the myriad of factors that prevent children from accessing timely cancer care in LMICs. The results will be submitted for publication in a peer-reviewed journal and shared with institutions related to the field.
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Affiliation(s)
| | - Andie Grimm
- Birmingham's Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama
| | | | | | - Kelsey Landrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kristin Schroeder
- Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
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9
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Singh P, Singh D, Kumar B, Kumar P, Bhadani PP. Profile and Clinical Outcome of Children with Wilms' Tumor treated at a Tertiary Care Centre, India. South Asian J Cancer 2022; 11:260-268. [PMID: 36588612 PMCID: PMC9803542 DOI: 10.1055/s-0042-1743414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Pritanjali SinghBackground Wilms' tumor (WT) is the most common kidney tumor of the pediatric age group. The outcome of WT has improved due to the evolution of the treatment approach. A prospective observational study was conducted at All India Institute of Medical Sciences (AIIMS), Patna, to analyze the clinical profile along with the response and outcome to neoadjuvant chemotherapy according to the International Society of Pediatric Oncology (SIOP) protocol. Materials and Methods In total, 28 patients of WT visited the radiotherapy department from January 2015 to December 2019. Results Gender distribution showed male preponderance with a median age at diagnosis was 31 months. The abdominal lump was the dominant clinical presentation. The median volume of tumor at diagnosis was 359.48 mL (52.67-1805.76). Radiological staging workup shows that stage I, II, III, IV, and V were 7.1%, 39.3%, 39.3%, 10.7%, and 3.6% respectively. Neoadjuvant chemotherapy (NACT) was received by all patients. Also, 71.4% of patients showed > 50% of tumor volume reduction, while 28.6% of patients showed < 50% of tumor mass reduction. There was a statistically significant decrease in the tumor volume reduction following neoadjuvant chemotherapy ( p < 0.001). There was a statistically significant stage down ( p = 0.018) of the disease. Bivariate correlation studies showed recurrence was correlating statistically significantly with age < 24 months ( p = 0.049), locoregional lymph nodes ( p = 0.008), histopathological subtypes ( p < 0.001), stage of the disease ( p = 0.003), and risk groups ( p < 0.001). In addition, 25% of patients developed recurrence during the median follow-up of 25 months. The median disease-free survival (DFS) and overall survival (OS) were not reached. The mean DFS and OS were 48 and 59.13 months, respectively. One- and 3-year DFS were 100% and 64.1%, respectively. One- and 3-year OS were 100% and 75% respectively. Conclusion Our study suggests that most of the patients presented at an advanced stage, thus rendering most of the cases difficult to undergo surgery at presentation. Neoadjuvant chemotherapy followed by surgery may be considered a well-balanced approach with a comparable response and survival outcomes.
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Affiliation(s)
- Pritanjali Singh
- Department of Radiotherapy, All India Institute of Medical Sciences, Patna, India
| | - Dharmendra Singh
- Department of Radiotherapy, All India Institute of Medical Sciences, Patna, India,Address for correspondence Dr Dharmendra Singh, MBBS, MD Department of Radiotherapy, All India Institute of Medical SciencesPhulwarisharif, Patna-801507, BiharIndia
| | - Bindey Kumar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Patna, India
| | - Prem Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, India
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10
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Umuerri EM, Odion-Obomhense HK. Nephroblastoma with Right Atrial Extension. J Cardiovasc Echogr 2021; 31:107-109. [PMID: 34485039 PMCID: PMC8388322 DOI: 10.4103/jcecho.jcecho_113_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/29/2021] [Indexed: 11/04/2022] Open
Abstract
Two-dimensional echocardiography is useful in the diagnosis of cardiac masses, including tumors. Cardiac metastasis of nephroblastoma heralds a worse prognosis. This 4-year-old child presented with clinical and radiological features suggestive of nephroblastoma. She had intracaval spread of the tumor to the right atrium. The cardiac metastasis was initially missed as echocardiography was not part of the routine workup for the patient as she had no clinical features suggestive of cardiac disease. Although cardiac metastasis of nephroblastoma is rare, we recommend routine transthoracic echocardiography for all patients irrespective of the presence of cardiac symptoms and signs.
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Affiliation(s)
- Ejiroghene Martha Umuerri
- Department of Medicine, Cardiology Unit, Delta State University Teaching Hospital, Delta State, Nigeria.,Department of Medicine, Cardiology Unit, Delta State University Teaching Hospital, Delta State, Nigeria
| | - Helen Kesiena Odion-Obomhense
- Department of Surgery, Delta State University, Abraka, Delta State, Nigeria.,Department of Surgery, Paediatric Surgery Unit, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
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Dijkstra S, Kraal KCJM, Ruijters VJ, Kremer LCM, Hoogerbrugge PM. Examining the Potential Relationship Between Multidisciplinary Team Meetings and Patient Survival in Pediatric Oncology Settings: A Systematic Review. J Pediatr Hematol Oncol 2021; 43:e873-e879. [PMID: 33003143 DOI: 10.1097/mph.0000000000001942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/15/2020] [Indexed: 12/13/2022]
Abstract
The organization of multidisciplinary team meetings (MTMs) has become standard practice in pediatric oncology and is widely felt to improve communication, knowledge, and patient care. Although the impact of MTMs on survival in adult oncology has been extensively researched, the potential benefits of survival for pediatric cancer patients are still unclear. This systematic review aimed to examine the impact of MTMs on survival in pediatric oncology settings. Relevant studies were identified by searching MEDLINE/PubMed, EMBASE, and the Cochrane Library databases up to January 2020, resulting in 325 unique records. After the title/abstract and full-text screening, 5 studies were included. All of the included studies (one prospective and 4 retrospective cohort studies) described a difference in overall or event-free survival when comparing patients who were discussed in MTMs with non-MTM patients. This association was statistically significant in 3 studies. The quality of the studies was strongly affected by their design. Because of the small number of studies in combination with high clinical and methodological heterogeneity, this review was unable to definitively assert a causal relationship between MTMs and survival in pediatric cancer patients. Further research is needed to explore this relationship and allow cost-benefit analyses, so that time and resources are optimally spent to deliver the best possible care to childhood cancer patients.
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Affiliation(s)
- Suzan Dijkstra
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Apple A, Lovvorn HN. Wilms Tumor in Sub-Saharan Africa: Molecular and Social Determinants of a Global Pediatric Health Disparity. Front Oncol 2020; 10:606380. [PMID: 33344257 PMCID: PMC7746839 DOI: 10.3389/fonc.2020.606380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/06/2020] [Indexed: 12/26/2022] Open
Abstract
Wilms tumor (WT) is the most common renal malignancy of childhood. Global disparities in WT have been reported with the highest incidence and lowest overall survival occurring in sub-Saharan African nations. After a detailed search of PubMed, we reviewed available literature on WT in sub-Saharan Africa and summarized findings that explore biologic and social factors contributing to this alarming cancer health disparity. Access to care and treatment abandonment are the most frequently reported factors associated with decreased outcomes. Implementation of multidisciplinary teams, collaborative networks, and financial support has improved overall survival in some nations. However, treatment abandonment remains a challenge. In high-income countries globally, WT therapy now is risk-stratified according to biology and histology. To a significantly lesser extent, biologic features have been studied only recently in sub-Saharan African WT, yet unique molecular and genetic signatures, including congenital anomaly-associated syndromes and biomarkers associated with treatment-resistance and poor prognosis have been identified. Together, challenges with access to and delivery of health care in addition to adverse biologic features likely contribute to increased burden of disease in sub-Saharan African children having WT. Publications on biologic features of WT that inform treatment stratification and personalized therapy in resource-limited regions of sub-Saharan Africa have lagged in comparison to publications that discuss social determinants of health. Further efforts to understand both WT biology and social factors relevant to appropriate treatment delivery should be prioritized in order to reduce health disparities for children residing in resource-limited areas of sub-Saharan Africa battling this lethal childhood cancer.
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Affiliation(s)
- Annie Apple
- Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Monroe Carrell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, United States
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Ekenze SO, Okafor OC, Obasi AA, Okafor DC, Nnabugwu II. Wilms tumor in Africa: A systematic review of management challenges and outcome in two decades (2000-2019). Pediatr Blood Cancer 2020; 67:e28695. [PMID: 32909662 DOI: 10.1002/pbc.28695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/05/2020] [Accepted: 08/24/2020] [Indexed: 01/10/2023]
Abstract
We performed a systematic review to highlight trends in management and outcome of Wilms tumor (WT) in Africa in the past two decades (2000-2019). Twenty-seven studies involving 2250 patients were analyzed. Overall, barring regional variations, 57.7% of the cases presented with advanced disease, 57.3% completed planned treatment, and survival was 56.5%. The publications in the two decades did not show significant differences in proportions of cases with advanced disease, completion of treatment rate, and cases lost to follow up. However, significantly more cases received preoperative chemotherapy, and survival improved in the last decade (2010-2019) compared to the earlier decade (2000-2009). Survival of WT in Africa might have improved in the last decade, but challenges of delayed presentation and abandonment of treatment have persisted. Measures that will encourage early access to expert care as well as improve on treatment compliance may further improve survival of WT in Africa.
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Affiliation(s)
- Sebastian O Ekenze
- Sub-Department of Pediatric Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Okechukwu C Okafor
- Department of Morbid Anatomy, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Akputa A Obasi
- Pediatric Surgery Unit, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - David C Okafor
- Pediatric Surgery Unit, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Ikenna I Nnabugwu
- Urology Unit, Department of Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
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Yağcı-Küpeli B, Özkan A. Syrian and Turkish children with cancer: a comparison on survival and associated factors. Pediatr Hematol Oncol 2020; 37:707-716. [PMID: 32705959 DOI: 10.1080/08880018.2020.1795328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cure rates of childhood cancer need to be improved in low-income countries and vulnerable populations such as refugees. We aimed to compare the outcome and associated factors in Syrian refugee and Turkish children with cancer treated at our hospital.Files of patients were reviewed for age, tumor type, stage, treatment, compliance to treatment, relapse or progression status, outcomes, secondary malignancy (SM) and treatment-related mortality (TRM). Overall (OS) and event-free survival rates (EFS) were analyzed.105 refugees and 304 Turkish children were treated between January 2012 and January 2019. Median age and median follow-up time were significantly lower in the Syrian group (p=0.046, p<0.001, respectively). Metastatic or advanced-stage disease was significantly more frequent in refugees (p=0.002). Relapse or progression and poor compliance to treatment were more common in refugees (p=0.01, p<0.001, respectively). Rates of OS were 55.7% and 69.7%, EFS were 28.9% and 55.7% in Syrian and Turkish patients. OS and EFS were lower in refugees compared to Turkish patients (p=0.01, p<0.001, respectively). EFS was significantly lower in refugees with poor compliance to treatment (p<0.001). TRM was reported in 12 (8 Syrian, 4 Turkish) patients. SM was detected in 3 (2 Turkish, 1 Syrian) children.Inferior survival rates were detected in Syrian refugee children compared to Turkish children. Besides from cancer-specific factors such as stage and tumor type, a series of barriers in accessing cancer care resulting in poor compliance to treatment might have been responsible from lower survival rates in Syrian children.
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Affiliation(s)
- Begül Yağcı-Küpeli
- Department of Pediatric Hematology/Oncology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Ayşe Özkan
- Department of Pediatric Hematology/Oncology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
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Ghafoor T, Bashir F, Ahmed S, Khalil S, Farah T. Predictors of treatment outcome of Wilms Tumour in low-income country; single centre experience from Pakistan. J Pediatr Urol 2020; 16:375.e1-375.e7. [PMID: 32224063 DOI: 10.1016/j.jpurol.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/04/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Wilms tumor (WT) represents around 85% of pediatric renal tumors. In high-income countries, 5-years survival of WT is above 90% but survival in developing countries is inferior. OBJECTIVE To identify the predictors of treatment outcome of WT in a developing country. METHODS A retrospective study conducted at the pediatric oncology department, Combined Military Hospital Rawalpindi, Pakistan. All newly diagnosed WT cases from 1st January 2012 who completed their treatment before 31st August 2019 were evaluated. Treatment was based on SIOP Wilms Tumour 2001/UK version 5. Patients presenting before nephrectomy received pre-operative chemotherapy. The postoperative chemotherapy regimen was decided according to the stage, risk stratification and metastatic status of the patient. RESULTS Data of 84 cases, including 40 (47.6%) males and 44 (52.4%) females was analyzed. The mean diagnostic age was 38.87 ± 28.66 months and 68 (81%) cases were less than five years of age. The commonest presenting features were abdominal mass in 75 (89.3%) cases. The right kidney was affected in 43 (51.2%) cases. Stage I disease was documented in 27 (32.1%) cases, stage II in 25 (29.8%), stage III in 13 (15.5%), and stage IV in 17 (20.2%) cases. In univariate analysis, advanced stage (P = < 0.001) and metastatic disease (P=< 0.001) adversely affected the treatment outcome. Multivariate analysis demonstrated that advanced stage WT was associated with the worst outcome (P= < 0.05). Four (4.8%) cases had treatment-related mortality (TRM). With a median follow-up time of 28.26 ± 23.03 months, OS and EFS were 66 (78.6%) and 63 (75.0%) respectively. DISCUSSION Delayed presentation with advanced-stage metastatic disease is quite common in the developing courtiers and is the major contributor to decreased EFS and OS. In the present study, 20.2% cases had metastatic disease, which is similar to reported from other developing countries. OS decreased from 92.6% in stage I to 47.1% in stage IV disease (P=< 0.001) and EFS decreased from 92.6% in stage I to 43.8% in stage IV disease (P=< 0.001). Very similar results are reported by a regional study [17]. Results in stage I and II disease are comparable to documented in the western world and inferior in advanced-stage disease. The strength of the present study is that multiple factors, affecting the treatment outcome of WT over almost seven years period were evaluated. CONCLUSIONS Stage of the disease is the most important prognostic factor. Delayed presentation with metastatic disease has a poor outcome.
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Affiliation(s)
- Tariq Ghafoor
- Armed Forces Bone Marrow Transplant Centre, CMH Medical Complex, Rawalpindi, Pakistan; Department of Pediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan.
| | - Farrah Bashir
- Department of Pediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Shakeel Ahmed
- Department of Pediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Sumaira Khalil
- Department of Pediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
| | - Tanzeela Farah
- Department of Pediatric Oncology, Combined Military Hospital, Rawalpindi, Pakistan
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