SIOP‐PODC adapted risk stratification and treatment guidelines: Recommendations for neuroblastoma in low‐ and middle‐income settings

Abstract

Neuroblastoma is the most common extracranial solid tumor in childhood in high‐income countries (HIC), where consistent treatment approaches based on clinical and tumor biological risk stratification have steadily improved outcomes. However, in low‐ and middle‐ income countries (LMIC), suboptimal diagnosis, risk stratification, and treatment may occur due to limited resources and unavailable infrastructure. The clinical practice guidelines outlined in this manuscript are based on current published evidence and expert opinions. Standard risk stratification and treatment explicitly adapted to graduated resource settings can improve outcomes for children with neuroblastoma by reducing preventable toxic death and relapse. Pediatr Blood Cancer 2015;62:1305–1316. © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc.

A framework to develop adapted treatment regimens to manage pediatric cancer in low‐ and middle‐income countries: The Pediatric Oncology in Developing Countries (PODC) Committee of the International Pediatric Oncology Society (SIOP)

“…However, if toxic death occurs in five of the next 25 patients treated with the Level 2 regimen, the stopping rule would be triggered and clinicians would know to step down to the Level 1 regimen and redouble efforts to improve supportive care. Decisions about the optimal regimen for a PCU would ideally fit within the context of regional and international disease‐specific networks, such as the Global Neuroblastoma Network where peers and colleagues provide advice about treatment regimens and specific patients and implemented in the context of regional collaboration networks such as those listed in Table …”

“…Meetings are conducted online via http://www.Cure4Kids.org and members listed on the SIOP website (http://www.siop-online.org). To date, working group members have published adapted regimens for seven cancers along with two supportive care manuscripts . The published adapted regimens were developed with broad input from clinicians in multiple disciplines, and experts from LMIC and HIC, and have been improved during extensive review by peers from the global oncology community.…”

Neuroblastoma in Late Adolescence: Case Report and Review of Literature

“…The patient was started on neoadjuvant chemotherapy commensurate with SIOPEN protocol after a multi-disciplinary tumor board discussion. 3 Five cycles of cisplatin, etoposide, doxorubicin and cyclophosphamide regimen was administered. Posttherapy scans showed more than 50% reduction in size ( Fig.…”

Improving Care for Children With Cancer in Low- and Middle-Income Countries-A SIOP PODC Initiative

“…Using the graduated intensity philosophy first proposed for the treatment of acute lymphoblastic leukemia, [39] the Adapted Treatment Regimens WG has produced pragmatic guidelines for the management of individual childhood cancers depending on the supportive care facilities available. [19][20][21][22][23][24][25] These guidelines were developed by physicians from LMIC and HIC. Several others including those on the management of children with Hodgkin lymphoma, osteosarcoma, acute myeloid leukemia, and an algorithm for nutritional assessment and intervention are in advanced stages of development.…”