Wilms tumour in Malawi: Surgical staging to stratify postoperative chemotherapy?

Outcomes are excellent for the majority of patients with Wilms tumors (WT). However, there remain WT subgroups for which the survival rate is approximately 50% or lower. Acknowledging that the composition of this high-risk group has changed over time reflecting improvements in therapy, we introduce the authors' view of the historical and current approach to the classification and treatment of high-risk WT. For this review, we consider high-risk WT to include patients with newly diagnosed metastatic blastemal-type or diffuse anaplastic histology, those who relapse after having been initially treated with three or more different chemotherapeutics, or those who relapse more than once. In certain low-or low middle-income settings, socio-economic factors expand the definition of what constitutes a high-risk WT. As conventional therapies are inadequate to cure the majority of high-risk WT patients, advancement of laboratory and early-phase clinical investigations to identify active agents is urgently needed.

Section: High‐risk Wilms Tumor In Low‐ and Low Middle‐income Countriesmentioning

confidence: 99%

Section: High-risk Wilms Tumor In Low-and Low Middle-income Countriesmentioning

confidence: 99%

Advances in the clinical management of high‐risk Wilms tumors

Ortiz

Koenig

Armstrong

et al. 2023

Section: High‐risk Wilms Tumor In Low‐ and Low Middle‐income Countriesmentioning

confidence: 99%

Section: High-risk Wilms Tumor In Low-and Low Middle-income Countriesmentioning

confidence: 99%

Advances in the clinical management of high‐risk Wilms tumors

Ortiz

Koenig

Armstrong

et al. 2023

Outcomes are excellent for the majority of patients with Wilms tumors (WT). However, there remain WT subgroups for which the survival rate is approximately 50% or lower. Acknowledging that the composition of this high‐risk group has changed over time reflecting improvements in therapy, we introduce the authors’ view of the historical and current approach to the classification and treatment of high‐risk WT. For this review, we consider high‐risk WT to include patients with newly diagnosed metastatic blastemal‐type or diffuse anaplastic histology, those who relapse after having been initially treated with three or more different chemotherapeutics, or those who relapse more than once. In certain low‐ or low middle‐income settings, socio‐economic factors expand the definition of what constitutes a high‐risk WT. As conventional therapies are inadequate to cure the majority of high‐risk WT patients, advancement of laboratory and early‐phase clinical investigations to identify active agents is urgently needed.

“…Almost all solid tumors require surgical resection for local control; moreover, completeness of tumor resection, assessment of regional spread, and delineation of the tumor bed help in decisions and planning regarding further therapy. [1][2][3][4][5] Intraoperative specimen orientation and delineation of areas with questionable margins are crucial for histopathological assessment of tumor resection. [1][2][3][4][5][6] Operative report documentation provides pathologists and oncologists with a valuable guide to determining tumor stage, need for therapy intensification, and/or additional surgical procedure(s).…”

Section: Introductionmentioning

confidence: 99%

Development of a template for operative reporting of pediatric cancer surgery in limited‐resource settings by using a modified Delphi method

Abdelhafeez,

Harrison,

Nugud

et al. 2023

PurposeA comprehensive operative report for cancer surgery is crucial for accurate disease staging, risk stratification, and therapy escalation/de‐escalation, which affects the outcome. Narrative operative reports may fail to include some critical findings. Furthermore, standardized operative reports can form the basis of a local registry, which is often lacking in limited‐resource settings (LRSs). In adult literature, synoptic operative reports (SOR) contain more key findings than narrative operative reports. In the LRSs, where the capacity of diagnostic pathology services is typically suboptimal, the value of a thorough operative report is even greater. The aim of this study was to develop a SOR template to help standardize childhood cancer surgery reporting in LRSs.MethodsTwenty‐three experts in pediatric cancer with extensive experience practicing in LRSs were invited to participate in a modified Delphi procedure. SOR domains for pediatric oncology surgery were drafted based on a literature search and then modified based on experts’ opinions. The experts anonymously answered multiple rounds of online questionnaires until all domains and subdomains reached a consensus, which was predefined as 70% agreement.ResultsSixteen experts participated in the study, and two rounds of the survey were completed. Twenty‐one domains were considered relevant, including demographics, diagnosis, primary site, preoperative disease stage, previous tumor biopsy or surgery, preoperative tumor rupture, neoadjuvant therapy, surgical access, type of resection, completeness of resection, tumor margin assessment, locoregional tumor extension, organ resection, intraoperative tumor spillage, vascular involvement, lymph node sampling, estimated blood loss, intraoperative complications and interventions to address them, specimen names, and specimen orientation.ConclusionWe developed a SOR template for pediatric oncology surgery in LRSs. Consensus for all 21 domains and associated subdomains was achieved using a modified Delphi procedure.