Treatment of Wilms tumor according to SIOP 9 protocol in Casablanca, Morocco

Madani, Abdellah; Zafad, S.; Harif, Mhamed; Yaakoubi, Mohammed; Zamiati, S.; Sahraoui, S.; Benjelloun, Amal; Fehri, M; Benchekroun, Saïd

doi:10.1002/pbc.20436

Cited by 51 publications

(42 citation statements)

References 20 publications

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“…Clinically more relevant is the resectability of tumours after preoperative chemotherapy; 14% of patients (8/58) had unresectable disease after preoperative chemotherapy and in six patients this was because of metastatic disease. These findings reflect late presentations, as does the fact that only 22% of tumours of the localized tumours were stage I at surgery in our study, compared to 64% in SIOP 9 and 53% in Casablanca [3,12]. There was also a high (20%) rate of tumour rupture at surgery, compared to 1-3% in the SIOP 9 study in localized tumours and to 21% (14/67) in a selected group of patients with tumours exceeding 1,000 g at surgery in Durban, South Africa [3,11].…”

Section: Discussionsupporting

confidence: 57%

The efficacy and toxicity of SIOP preoperative chemotherapy in Malawian children with a Wilms tumour

Israëls

Chagaluka

Pidini

et al. 2012

Pediatric Blood & Cancer

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BackgroundIn Malawi, preoperative chemotherapy for Wilms tumour is a logical strategy, but detailed information on toxicity and efficacy in such a resource limited setting has been unavailable.ProcedurePatients diagnosed with a unilateral Wilms tumour received preoperative chemotherapy—a two‐drug 4‐week regimen for localized disease and 6 weeks of a three‐drug regimen for metastatic disease. Estimated maximum tumour diameter, decrease in tumour size, resectability, stage distribution and haematological toxicity during therapy were documented.ResultsAt diagnosis, 28% of 72 patients had an estimated maximum tumour diameter of more than 25 cm; 29% of patients had metastases. Eight children (11%) died during preoperative chemotherapy. More than half (59%) of the patients developed moderate neutropenia (neutrophils <1.0 × 109/L; CTC grade 3) and 27% severe neutropenia (CTC grade 4 neutrophils <0.5 × 10.9/L). Grade 4 neutropenia occurred significantly more frequently in children receiving the three‐drug regimen compared to the two‐drug regimen; 50% (10/20) versus 15% (6/40) (P = 0.004). Fifty‐seven percent of all patients had CTC grade 4 anaemia (Hb < 6.5 g/dL) during treatment. Most tumours (92%, 56/61) showed a response to chemotherapy but 14% (8/58) remained unresectable.ConclusionPreoperative chemotherapy for Wilms tumour causes considerable haematological toxicity and treatment‐related mortality in malnourished Malawian children. A significant number of children have unresectable disease despite preoperative chemotherapy. To reduce treatment related mortality, consideration should be given to starting treatment with reduced doses in acutely malnourished patients. Pediatr Blood Cancer 2012;59:636–641. © 2012 Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 57%

The efficacy and toxicity of SIOP preoperative chemotherapy in Malawian children with a Wilms tumour

Israëls

Chagaluka

Pidini

et al. 2012

Pediatric Blood & Cancer

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“…The LTFU rate was 13.2%, which is less than the 20% reported in a Moroccan cohort. 22 This is perhaps a result of subsidized chemotherapy and social supports at BCCOE 5,6 ; however, we currently do not have sufficient data to evaluate contributing factors. Relapse rates may also be probed in the future with additional data.…”

Section: Discussionmentioning

confidence: 99%

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

Shyirambere

Elmore

et al. 2016

JGO

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PurposeSuccess in treating nephroblastoma in high-income countries has been transferred to some resource-constrained settings; multicenter studies report disease-free survival of greater than 70%. However, few reports present care models with rural-based components, care tasks shifted to internists and pediatricians, and data collection structured for monitoring and evaluation. Here, we report clinical outcomes and protocol compliance for patients with nephroblastoma evaluated at Butaro Cancer Center of Excellence in Rwanda.Patients and MethodsThis retrospective study reports the care of 53 patients evaluated between July 1, 2012, and June 30, 2014. Patients receiving less than half of their chemotherapy at Butaro Cancer Center of Excellence were excluded.ResultsOf the 53 patients included, 9.4% had stage I, 13.2% had stage II, 24.5% had stage III, 26.4% had stage IV, and 5.7% had stage V disease; the remaining 20.8% had unknown stage disease from inadequate work-up or unavailable surgical report. The incidence of neutropenia increased with treatment progression, and the greatest proportion of delays occurred during the surgical referral phase. At the end of the study period, 32.1% of patients (n = 17) remained alive after treatment; 24.5% (n = 13) remained alive while continuing treatment, including one patient with recurrent disease; 30.2% (n = 16) died; and 13.2% (n = 7) were lost to follow-up.ConclusionOur findings confirm that nephroblastoma can be effectively treated in resource-constrained settings. Using an approach in which chemotherapy is delivered at a rural-based center by nononcologists and data are used for routine evaluation, care can be delivered in safe, novel ways. Protocol modifications to mitigate chemotherapy toxicities and strong communication between the multidisciplinary team members will likely minimize delays and further improve outcomes in similar settings.

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“…The units with an established multidisciplinary approach before the beginning of this study treated the largest number of patients according to the protocol [10,11]. Some units were unable to contribute significantly to this study either because the surgeons were not convinced of the value of preoperative chemotherapy or because of a paucity of resources at all levels.…”

Section: Discussionmentioning

confidence: 99%

“…The SIOP studies demonstrated the value of preoperative chemotherapy [3] to limit the risk of tumor rupture during surgery, to increase the percentage of stage I tumors requiring less aggressive treatments and to limit complications associated with surgery [9]. In Africa, the results of such treatment management are fragmentary [10][11][12][13] or are unknown.…”

Section: Introductionmentioning

confidence: 99%

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

Moreira

Nachef²,

Ziamati

et al. 2011

Pediatric Blood & Cancer

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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.

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Treatment of Wilms tumor according to SIOP 9 protocol in Casablanca, Morocco

Abstract: These results are encouraging for a developing country but special efforts should be done to reduce the rate of abandonment.

Cited by 51 publications

References 20 publications

The efficacy and toxicity of SIOP preoperative chemotherapy in Malawian children with a Wilms tumour

The efficacy and toxicity of SIOP preoperative chemotherapy in Malawian children with a Wilms tumour

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

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

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