Improved care of rhabdomyosarcoma in Jordan using less intensive therapy

Abstract

BackgroundThe care of rhabdomyosarcoma (RMS) is complex due to its multimodal nature. By following standard protocols with acceptable toxicity and building local expertise, better outcome should be achievable.ProcedureA retrospective study was conducted of records of patients (n = 45; 31 males; median age 26 months) with RMS treated at King Hussein Cancer Center in Jordan from January 2004 to December 2008. Patient demographics, tumor characteristics, risk stratification, treatment plan, and outcomes were studied. In June 2006, the cyclophosphamide dose was lowered from 2.2 g/m2 to 1.2 g/m2 per cycle because of the significant toxicity with higher dose. Survival rates, hematological toxicities, period of hospitalization due to febrile neutropenia (FN), and response rate at week 12 of treatment were compared between low‐ and high‐dose cyclophosphamide groups.ResultsFour‐year progression‐free survival (PFS) and overall survival (OS) rates were 61% ± 7.5% and 72% ± 6.9%, respectively. There was a significant difference in outcome by risk group in 4‐year PFS (low‐risk, 88% ± 12%; intermediate‐risk 63% ± 9.3%; high‐risk, 14% ± 13%; P = 0.0001) and OS (low‐risk, 88% ± 12%; intermediate‐risk 79% ± 7.5%; high‐risk, 17% ± 15%; P = 0.0011). There was significant reduction in hematological toxicities, incidence of FN, and period of hospitalization for FN in patients given low‐dose cyclophosphamide but no significant difference in PFS between low‐ and high‐dose cyclophosphamide groups.ConclusionsSurvival rates of patients with RMS in some developing countries can be improved by following or modifying evidence‐based approaches successful in developed countries and establishing multidisciplinary strategies. Therapy intensity should be increased in developing countries only when evidence supports its utility. Pediatr Blood Cancer 2013; 60: 53–58. © 2012 Wiley Periodicals, Inc.

Rhabdomyosarcoma in low‐ and middle‐income countries: A report from the Asociacion de Hemato‐oncología Pediatrica de Centro América (AHOPCA)

“…This study showed that the survival rates achieved in high‐income countries with treatments for children with RMS were unlikely to be reproduced in Central America. The AHOPCA results are similar to those reported in other resource‐limited settings 9–13,22–25 . However, this finding is at odds with the results obtained with treatments for other pediatric malignancies, such as retinoblastoma 26 and Hodgkin 27 or non‐Hodgkin lymphomas, 28 for which the survival rates achieved with AHOPCA protocols were not so different from those usually reported in developed countries.…”

“…The AHOPCA results are similar to those reported in other resource-limited settings. [9][10][11][12][13][22][23][24][25] However, this finding is at odds with the results obtained with treatments for other pediatric malignancies, such as retinoblastoma 26 and Hodgkin 27 or non-Hodgkin lymphomas, 28 for which the survival rates achieved the years to reduce the rate of patients abandoning their treatments, including programs for social workers covering advocacy and community education, and financial support for families. 29,30 Our analysis suggested that a main cause of the survival gap between Central America and developed countries may concern the quality of local control (local progression/relapse was the main cause of treatment failure).…”

“…Unfortunately, the therapeutic standards achieved in high‐income countries seem unlikely to be reproduced in low‐ and middle‐income countries (LMIC). This gap may relate to diverse factors, such as the complexity and cost of the treatment, patient and family compliance, low awareness of the disease, delay in diagnosis (and the consequently high proportion of cases with already advanced disease), limited access to multimodal care, and poor quality of local control therapy 9–14 …”

“…This gap may relate to diverse factors, such as the complexity and cost of the treatment, patient and family compliance, low awareness of the disease, delay in diagnosis (and the consequently high proportion of cases with already advanced disease), limited access to multimodal care, and poor quality of local control therapy. [9][10][11][12][13][14] Since 1998, the Asociación de Hemato-oncología Pediatrica de Centro América (AHOPCA), or Central American Association for Pediatric Hematology and Oncology 15 -a consortium of LMIC-has been working to bridge the gap in the quality of treatment for disadvantaged children with cancer through partnerships with institutions in Europe and North America. 16,17 The AHOPCA network currently includes 8 coun-…”

Global challenges in pediatric oncology

“…1). Несмотря на эти ограничения, успешные результаты были достигнуты в лечении солидных новообразований, таких как ретинобластома [35], саркома [70,71] 20 П р о г р е с с в д е т с к о й г е м а т о л о г и и -о н к о л о г и и в X X I в е к е В то время как глобальные инициативы в области здравоохранения для терапии онкологических заболеваний у детей становятся все более распространенными, параллельно проводится работа в области детской гематологии. Аналогично ЗН, ежегодно примерно 80 % новорожденных детей в странах с низким и средним уровнем доходов страдают гемоглобинопатиями.…”