Treatment of nephroblastoma in Africa: Results of the first French African pediatric oncology group (GFAOP) study

Abstract

BackgroundThe multidisciplinary management of nephroblastoma has been defined through multicentric prospective studies and an average 90% of patients cured expected. In Africa, such studies are uncommon and results are fragmentary or unknown in most of the countries. We report the results of the GFAOPNEPHRO 01 study using SIOP 2001 protocol approach.ProcedureFrom April 1, 2001 to March 31, 2004, 8 African Pilot Units were selected to participate in a nonrandomized prospective study. All patients referred with a clinical and radiological diagnosis of nephroblastoma were registered, those aged over 6 months and less than 18 years with a unilateral tumor not previously treated were included in this study and received preoperative chemotherapy. Patients with unfavorable histology or with a tumor other than Wilms tumor, and those with stage IV tumor and persistent disease after surgery were secondarily excluded.ResultsOf the 229 patients initially registered, 166 were included and finally 133 retained in the study, after surgery. Tumor rupture occurred in 7.5% of the patients. Thirty‐five percent were stage I, 22% stage II, 23% stage III, and 18% stage IV. Two‐year disease‐free survival and 5‐year survival are, respectively: 77.9% and 76.7% for localized tumors, 72.7% and 71.6% for all study patients.ConclusionsIt is possible to conduct African multicentric therapeutic studies within the framework of GFAOP. Results in terms of event‐free survival and survival are satisfactory. Improvements with respect to procedure, data collection, and outcome are expected in a new study. Pediatr Blood Cancer 2012; 58: 37–42. © 2011 Wiley Periodicals, Inc.

Risk factors for abandonment of Wilms tumor therapy in Kenya

“…[3, 16] It is clear that proper support and infrastructure results in markedly improved outcomes for patients with WT in Africa. In Casablanca, Morocco, authors reported a 5-year OS of 79% from WT by following SIOP-9 treatment protocols.…”

SIOP PODC: Clinical guidelines for the management of children with Wilms tumour in a low income setting

“…Typical presentation of a child with Wilms tumour in a low income setting is a malnourished child of about 3 years with a large abdominal or flank mass, who is relatively well without acute pain or severe general malaise, but with haematuria and hypertension [3,4].…”

“…Survival in low income countries is much lower than in high income countries with reported survival in low income settings in sub-Saharan Africa ranging from 11% to 50% [3][4][5][6][7]. Known challenges are late presentation with advanced disease, malnutrition, failure to complete treatment and poorer facilities both for the specific cancer treatment and also for supportive care [4,5,8].…”

“…Known challenges are late presentation with advanced disease, malnutrition, failure to complete treatment and poorer facilities both for the specific cancer treatment and also for supportive care [4,5,8]. Capacity building, earlier presentation, social support, improved supportive care and a treatment guideline adapted to local circumstances are key to improving results [6,9,10].…”

Treating Nephroblastoma in Rwanda: Using International Society of Pediatric Oncology Guidelines in a Novel Oncologic Care Model

“…2 In contrast, survival rates in African settings are generally less than 45%, although one recent collaborative effort achieved an event-free survival rate of 77%. 3-8 This outcome disparity reflects lack of access to high-quality, multidisciplinary oncologic care, with many cancer facilities often situated in urban centers and within the private sector. 9-12 …”