Wilms tumour with unfavourable histology: Implications for clinicians in the third world

Hadley, G. P.; Govender, Dhirendra; Landers, Grant

doi:10.1002/mpo.1145

“…Root causes for abandonment of therapy are complex and include socioeconomic pressures, geographic barriers, disparities in health literacy, and cultural biases [ 21 , 22 ]. Inability to complete therapy on an outpatient basis has led clinicians in some settings to take the dramatic step of admitting children from remote provinces for the entire duration of their chemotherapy [ 23 ]. Fear of hospital detention may contribute to delayed presentation and/or abandonment of therapy [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care

Carter

¹

,

Avery

²

,

Libes

³

et al. 2018

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International disparities in outcomes from pediatric solid tumors remain striking. Herein, we review the current literature regarding management, outcomes, and barriers to care for pediatric solid tumors in low- and middle-income countries (LMICs). In sub-Saharan Africa, Wilms Tumor represents the most commonly encountered solid tumor of childhood and has been the primary target of recent efforts to improve outcomes in low-resource settings. Aggressive and treatment-resistant tumor biology may play a role in poor outcomes within certain populations, but socioeconomic barriers remain the principal drivers of preventable mortality. Management protocols that include measures to address socioeconomic barriers have demonstrated early success in reducing abandonment of therapy. Further work is required to improve infrastructure and general pediatric care to address disparities.

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“…The lack of referral centers with high surgical expertise correlates with a higher incidence of tumor rupture and suboptimal surgical staging 74,77 . The limited access to supportive care, RT, and certain chemotherapy medications (i.e., carboplatin, alkylating agents) limit the ability to intensify therapy in high‐risk tumors 68,78,79 . The combination of underdiagnosis of metastatic disease, later detection of tumors, and lack of central pathology review could explain the lower survival for middle‐income countries (MIC) compared with HIC, as was seen in the international comparison of outcomes in the SIOP WT 2001 trial for the Brazilian group 69 .…”

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

confidence: 99%

“…74,77 The limited access to supportive care, RT, and certain chemotherapy medications (i.e., carboplatin, alkylating agents) limit the ability to intensify therapy in highrisk tumors. 68,78,79 The combination of underdiagnosis of metastatic disease, later detection of tumors, and lack of central pathology review could explain the lower survival for middle-income countries (MIC) compared with HIC, as was seen in the international comparison of outcomes in the SIOP WT 2001 trial for the Brazilian group. 69 We also need to acknowledge that the lack of cancer registries with all information limits the capacity of LMIC to determine the actual incidence of high-risk WT.…”

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

¹

,

Koenig

²

,

Armstrong

³

et al. 2023

Pediatric Blood & Cancer

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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.

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“…The lack of referral centers with high surgical expertise correlates with a higher incidence of tumor rupture and suboptimal surgical staging 74,77 . The limited access to supportive care, RT, and certain chemotherapy medications (i.e., carboplatin, alkylating agents) limit the ability to intensify therapy in high‐risk tumors 68,78,79 . The combination of underdiagnosis of metastatic disease, later detection of tumors, and lack of central pathology review could explain the lower survival for middle‐income countries (MIC) compared with HIC, as was seen in the international comparison of outcomes in the SIOP WT 2001 trial for the Brazilian group 69 .…”

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

confidence: 99%

“…74,77 The limited access to supportive care, RT, and certain chemotherapy medications (i.e., carboplatin, alkylating agents) limit the ability to intensify therapy in highrisk tumors. 68,78,79 The combination of underdiagnosis of metastatic disease, later detection of tumors, and lack of central pathology review could explain the lower survival for middle-income countries (MIC) compared with HIC, as was seen in the international comparison of outcomes in the SIOP WT 2001 trial for the Brazilian group. 69 We also need to acknowledge that the lack of cancer registries with all information limits the capacity of LMIC to determine the actual incidence of high-risk WT.…”

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

¹

,

Koenig

²

,

Armstrong

³

et al. 2023

Pediatric Blood & Cancer

View full text Add to dashboard Cite

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.

show abstract

Wilms tumour with unfavourable histology: Implications for clinicians in the third world

Cited by 6 publications

References 9 publications

Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care

Pediatric Solid Tumors in Resource-Constrained Settings: A Review of Available Evidence on Management, Outcomes, and Barriers to Care

Advances in the clinical management of high‐risk Wilms tumors

Advances in the clinical management of high‐risk Wilms tumors

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