Treating Pediatric soft tissue sarcomas in a country with limited resources: The experience of the Unidad Nacional de Oncologia Pediatrica in Guatemala

Antillón, Federico; Castellanos, Mauricio; Valverde, Patricia; Luna‐Fineman, Sandra; Garrido, Clàudia; Serrato, Tania; Rodríguez‐Galindo, Carlos; Casanova, Michela; Ferrari, Andrea

doi:10.1002/pbc.21699

Cited by 18 publications

(32 citation statements)

References 15 publications

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“…The treatment of children with cancer in developing countries faces many obstacles, such as patient and family compliance, cost, delayed diagnosis, low awareness of disease, and poor access to multimodal care [7]. In this study, we report the outcomes of children with RMS in a single institution in Jordan.…”

Section: Discussionmentioning

confidence: 99%

“…Despite improved outcomes of children with RMS in developed countries, survival rates of patients in limited-resource countries continue to remain poor [7]. Obstacles to the management of RMS in limited-resource nations include complexity of treatment, cost of therapy, and families' compliance [7].…”

Section: Introductionmentioning

confidence: 99%

“…Obstacles to the management of RMS in limited-resource nations include complexity of treatment, cost of therapy, and families' compliance [7]. At the King Hussein Cancer Center (KHCC), children with RMS are managed by a multidisciplinary team (comprising of pediatric oncologists, pediatric surgeons, radiation oncologists, radiologists, pathologists, and psycho-social team).…”

Section: Introductionmentioning

confidence: 99%

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Improved care of rhabdomyosarcoma in Jordan using less intensive therapy

Al-Jumaily

Ayaad

Masarweh

et al. 2012

Pediatric Blood & Cancer

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improved care of rhabdomyosarcoma in Jordan using less intensive therapy

Al-Jumaily

Ayaad

Masarweh

et al. 2012

Pediatric Blood & Cancer

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“…This volume included clinically involved lymph nodes. An additional margin of 1.5-2 cm around the GTV was generated to create the clinical target volume (CTV), then an additional 0.5 cm margin was taken around the [9][10][11][12], then every 2-3 months. Survival was defined as the time interval from diagnosis to either death from any cause or last follow-up.…”

Section: We Conducted a Retrospective Review Of Medical Records Of Pamentioning

confidence: 99%

“…The outcome of patients treated in low-resource and developing countries is much worse, as reported by retrospective single institution and national studies [9][10][11][12][13][14]. The contribution of ethnic differences in biology, versus lack of delivery of adequate therapy, to this adverse outcome has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Rhabdomyosarcoma Treatment and Outcome at a Multidisciplinary Pediatric Cancer Center in Lebanon

Salman

Tamim

Medlej

et al. 2012

Pediatric Hematology and Oncology

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Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. Outcome of patients treated on standard protocols, in a multidisciplinary cancer center setting outside of clinical trials, is not well reported. We reviewed characteristics and outcome of 23 pediatric patients treated at a single, multidisciplinary cancer center in Lebanon, between April 2002 and December 2010. Median follow-up was 41 months. The most commonly affected primary site was the head and neck (48%, n = 11). Nineteen tumors (82.6%) were of embryonal histology. Tumor size was ≥5 cm in eight (34.8%) patients. Sixteen patients (69.6%) had localized disease, and one (4.4%) had metastatic disease. Fifteen (65.2%) had Group III tumors. All patients received chemotherapy, for a duration ranging 21-51 weeks. Upfront surgical resection was performed in 10 patients (43.5%). Eighteen patients (78.3%) received radiation therapy. The 5-year overall and disease-free survival rates were 83% and 64%, respectively. Relapse correlated with absence of surgery. Treatment of childhood RMS in a multidisciplinary cancer center in Lebanon results in similar survival to that in developed countries when similar protocols are applied. There was a higher incidence of local relapse, but those were salvageable with further therapy and surgical local control.

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Treatment including anthracyclines versus treatment not including anthracyclines for childhood cancer

Dalen

Raphaël

Caron

et al. 2011

Cochrane Database of Systematic Reviews

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At the moment no evidence from RCTs is available which underscores the use of anthracyclines in ALL. However, "no evidence of effect", as identified in this review, is not the same as "evidence of no effect". For Wilms' tumour, rhabdomyosarcoma/undifferentiated sarcoma, Ewing's sarcoma, non-Hodgkin lymphoma and hepatoblastoma only one RCT was available and, therefore, no definitive conclusions can be made about the antitumour efficacy of treatment with or without anthracyclines in these tumours. For other childhood cancers no RCTs were identified and therefore, no conclusions can be made about the antitumour efficacy of treatment with or without anthracyclines in these tumours.

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Treating Pediatric soft tissue sarcomas in a country with limited resources: The experience of the Unidad Nacional de Oncologia Pediatrica in Guatemala

Cited by 18 publications

References 15 publications

Improved care of rhabdomyosarcoma in Jordan using less intensive therapy

Improved care of rhabdomyosarcoma in Jordan using less intensive therapy

Rhabdomyosarcoma Treatment and Outcome at a Multidisciplinary Pediatric Cancer Center in Lebanon

Treatment including anthracyclines versus treatment not including anthracyclines for childhood cancer

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