Pediatric Hematology and Oncology最新文献

{"title":"Estimation of iron overload with T2*MRI in children treated for hematological malignancies.","authors":"Vinay Munikoty,&nbsp;Kushaljit Singh Sodhi,&nbsp;Anmol Bhatia,&nbsp;Prateek Bhatia,&nbsp;Savita Verma Attri,&nbsp;Manoj K Rohit,&nbsp;Amita Trehan,&nbsp;Niranjan Khandelwal,&nbsp;Deepak Bansal","doi":"10.1080/08880018.2022.2098436","DOIUrl":"https://doi.org/10.1080/08880018.2022.2098436","url":null,"abstract":"<p><p>Iron overload may contribute to long-term complications in childhood cancer survivors. There are limited reports of assessment of tissue iron overload in childhood leukemia by magnetic resonance imaging (MRI). A cross-sectional, observational study in children treated for hematological malignancy was undertaken. Patients ≥6 months from the end of therapy who had received ≥5 red-cell transfusions were included. Iron overload was estimated by serum ferritin (SF) and T2*MRI. Forty-five survivors were enrolled among 431 treated for hematological malignancies. The median age at diagnosis was 7-years. A median of 8 red-cell units was transfused. The median duration from the end of treatment was 15 months. An elevated SF (>1,000 ng/ml), elevated liver iron concentration (LIC) and myocardial iron concentration (MIC) were observed in 5 (11.1%), 20 (45.4%), and 2 (4.5%) patients, respectively. All survivors with SF >1,000 ng/ml had elevated LIC. The LIC correlated with SF (<i>p</i> < 0.001). MIC lacked correlation with SF or LIC. Factors including the number of red-cell units transfused and duration from the last transfusion were associated with elevated SF (<i>p</i> = 0.001, 0.002) and elevated LIC (<i>p</i> = 0.012, 0.005) in multiple linear regression. SF >595 ng/ml predicted elevated LIC with a sensitivity of 85% and specificity of 91.6% (AUC 91.2%). A cutoff >9 units of red cell transfusions had poor sensitivity and specificity of 70% and 75% (AUC 76.6%) to predict abnormal LIC. SF >600 ng/ml is a robust tool to predict iron overload, and T2*MRI should be considered in childhood cancer survivors with SF exceeding 600 ng/ml.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"315-325"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9733642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global caregiver concerns of SARS-CoV-2 vaccination in children with cancer: a cross-sectional mixed-methods study.","authors":"Julia M Gumy,&nbsp;Allison Silverstein,&nbsp;Erica C Kaye,&nbsp;Miguela A Caniza,&nbsp;Maysam R Homsi,&nbsp;Kathy Pritchard-Jones,&nbsp;Jessica M Bate","doi":"10.1080/08880018.2022.2101724","DOIUrl":"https://doi.org/10.1080/08880018.2022.2101724","url":null,"abstract":"<p><p>The objective of this study was to understand global caregiver concerns about SARS-CoV-2 vaccination for children with cancer and to provide healthcare providers with guidance to support parental decision-making. A co-designed cross-sectional mixed-methods survey was distributed to primary caregivers of children with cancer globally between April and May 2021 via several media. Caregivers were asked to rate the importance of vaccine-related questions and the median scores were ranked. Principal Component Analysis was conducted to identify underlying dimensions of caregiver concerns by World Bank income groups. Content analysis of free-text responses was conducted and triangulated with the quantitative findings. 627 caregivers from 22 countries responded to the survey with 5.3% (<i>n</i> = 67) responses from low-and-middle-income countries (LMIC). 184 caregivers (29%) provided free-text responses. Side effects and vaccine safety were caregivers' primary concerns in all countries. Questions related to logistics were of concern for caregivers in LMIC. A small minority of caregivers (<i>n</i> = 17) did not consider the survey questions important; free-text analysis identified these parents as vaccine hesitant, some of them quoting safety and side effects as main reasons for hesitancy. Healthcare providers and other community organizations globally need to provide tailored information about vaccine safety and effectiveness in pediatric oncology settings. Importantly, continued efforts are imperative to reduce global inequities in logistical access to vaccines, particularly in LMIC.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 4","pages":"341-351"},"PeriodicalIF":1.7,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9437130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward 2030: SIOP Africa adopts the Global Initiative for Childhood Cancer.","authors":"Joyce Balagadde-Kambugu,&nbsp;Alan Davidson,&nbsp;Laila Hessissen,&nbsp;Glenn Mbah Afungchwi,&nbsp;Jeannette Parkes,&nbsp;Jaques van Heerden,&nbsp;Jennifer Geel","doi":"10.1080/08880018.2022.2117883","DOIUrl":"https://doi.org/10.1080/08880018.2022.2117883","url":null,"abstract":"Implementation of the World Health Organization (WHO) Global Initiative for Childhood Cancer (GICC) has galvanized efforts to improve childhood cancer services across Africa, by providing the CureAll framework.1 The benefits to being a GICC implementing country are that attention can be focused on identifying needs by convening stakeholders to define shared objectives, increasing the capacity of a country to manage childhood cancer and developing best practices.1 Ghana, Morocco, Senegal, Zambia and Zimbabwe are currently focus countries with South Africa, Mali, Cameroon and Uganda in the early stages of implementation.2 The acronym CureAll highlights the four essential pillars of the framework: 1) adequately staffed Centers of excellence and care networks, 2) Universal health coverage (UHC) 3) context-appropriate treatment and diagnostic Regimens and roadmaps, and 4) Evaluation and monitoring. These pillars are underpinned by cross-cutting foundational enablers: Advocacy, Leveraged financing, and Linked governance.1 The initiative envisions the unification of diverse stakeholders including patients, families, multidisciplinary pediatric oncology teams and governments, to improve pediatric oncology services. In resource-limited settings, strong leadership is essential in applying available tools in innovative ways to achieve these results. Meeting the 2030 target of 60% survival, double the current estimate, can only be achieved by a unified team approach. SIOP Africa has enthusiastically embraced this framework to improve services for children with cancer and achieve its ambitious goals. Assuming a modest age-standardized ratio of 100 cancers per million children under 15 per year, and a population of 1.2 billion with 40% under the age of 15, there are at least 48 000 new cases in Africa annually.3,4 Many go undiagnosed and report low survival rates, therefore overestimate true survival. Current data only reflect outcomes of those who have accessed services.","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"197-202"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9286696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chemotherapy supply chain management, safe-handling and disposal in Ethiopia: the case of Tikur Anbessa specialized hospital.","authors":"Atalay Mulu Fentie,&nbsp;Zelalem Tilahun Mekonen,&nbsp;Zelalem Gizachew,&nbsp;Mahlet Hailemariam,&nbsp;Stephen M Clark,&nbsp;Jaime Richardson,&nbsp;Benyam Muluneh","doi":"10.1080/08880018.2022.2139028","DOIUrl":"https://doi.org/10.1080/08880018.2022.2139028","url":null,"abstract":"<p><p>Optimal chemotherapy management is substandard in low and middle-income countries. We aimed to identify major gaps to design interventional strategies for improved chemotherapy management at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. This study was conducted using an observational checklist, open-ended questions, record review, and key informant interviews of department heads and focal persons at TASH. Findings were categorized into specific themes that developed. Chemotherapy represented 60.2% of the hospital medication budget. Drug utilization was quantified via monthly consumption documentation and forecasting. However, unreliable data resulted in frequent stockouts (unavailability of the item when it is needed) of chemotherapy with only 67.8% availability. Thirteen healthcare personnel (9 nurses, 2 pharmacists and 2 hospital cleaners) were interviewed: all clinical staff but neither of hospital cleaners believed that they were at risk of hazardous agents. Challenges identified included inadequate and frequent stockouts (unavailability of the item when it is needed) of personal protective equipment, lack of standardized guidelines for chemotherapy handling, admixture, and disposal, lack of designated preparation rooms, and lack of training. All nine nurses handled chemotherapy admixtures despite only two nurses previously receiving in-service training. Most of the participants had never witnessed the disposal of anticancer drugs. Prompted by the results of this study, a dialogue was initiated among members of TASH, the American Cancer Society and the University of North Carolina to implement action-oriented projects to address the gaps identified at TASH. These gaps directly and indirectly affect care and treatment outcomes of patients at a large cancer center. Collaborations with well-resourced centers are potential models for improving chemotherapy management.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"258-266"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9585027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A retrospective evaluation of the presentation, prognostic factors and outcomes of neuroblastoma in Ugandan children.","authors":"Irene Nanyanga,&nbsp;Gideon Kurigamba Kwikiriza,&nbsp;Barnabas Atwiine,&nbsp;Ruth Namazzi,&nbsp;Victor Musiime,&nbsp;Joyce Balagadde Kambugu,&nbsp;Jaques van Heerden","doi":"10.1080/08880018.2022.2159593","DOIUrl":"https://doi.org/10.1080/08880018.2022.2159593","url":null,"abstract":"<p><p>Neuroblastoma (NB) is the most common extracranial solid tumor of childhood. The complete burden and outcomes in Uganda are unknown. The study was a multicenter retrospective chart review of children aged between 0 to 15 years diagnosed with NB from 2010 to 2020. Demographic, clinical and tumor-related characteristics were extracted for analysis. Kaplan-Meier survival curves and Cox regression models were used to determine the one-year overall survival (OS) and identify prognostic factors. Seventy-five patients were evaluated, with a median age at diagnosis of 48 months (IQR 26-108 months). Fever (74.7%), weight loss (74.7%), high blood pressure (70.3%) and abdominal swelling/mass (65.3%) were the most common features at diagnosis. Suprarenal tumors (52%) and stage 4 disease (70.7%) were also common. The one-year OS was 60.0% (95%CI 56.8%; 64.3%) with a median survival time of 12.6 months (95% CI: 8.1; 20.8). The one-year OS for non-metastatic and metastatic disease was 67.3% and 42.6% (<i>p</i> = 0.11) respectively. Leukocytosis (<i>p</i> < 0.001) at diagnosis was of prognostic significance while clinical remission after induction chemotherapy (<i>p</i> < 0.001) provided survival advantages. Children who received maintenance chemotherapy had a longer median survival time of 38.5 months (range 10.8-69.5). Age (<i>p</i> = 0.001), lung metastasis (<i>p</i> < 0.001), and leukocytosis (<i>p</i> < 0.001) remained significant on multivariate analysis. In this Ugandan study, leukocytosis was a clinical predictor of prognosis, metastatic disease had management challenges and maintenance chemotherapy prolonged the survival time but not OS.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"281-299"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9232620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinicopathological profile and value of multidisciplinary management of pediatric brain tumors in a low-income setting.","authors":"Richard Nyeko,&nbsp;Joyce Balagadde Kambugu,&nbsp;Racheal Angom,&nbsp;Hussein Senyonjo,&nbsp;Solomon Kibudde,&nbsp;Fadhil Geriga,&nbsp;Jaques van Heerden","doi":"10.1080/08880018.2022.2140861","DOIUrl":"https://doi.org/10.1080/08880018.2022.2140861","url":null,"abstract":"<p><p>Brain tumors are the most common solid tumors in children and a leading cause of cancer-related mortality in children worldwide. Data on the epidemiology and management of pediatric brain tumors in Uganda are limited. We aimed to assess the clinicopathological profile and management of pediatric brain tumors at the national oncology center in Uganda since the inception of weekly multidisciplinary meetings. Records of children younger than19 years diagnosed with primary brain tumors at Uganda Cancer Institute between 2017 and 2021 were retrospectively reviewed. Patient and tumor characteristics were collected with multidisciplinary team management treatment plans for analysis. There were 35 patients evaluated, most of whom were males (57.1%). Craniopharyngioma (n = 9, 25.7%) was the most common brain tumor, followed by astrocytoma (n = 5, 14.2%) and medulloblastoma (n = 4, 11.4%). Management included surgical resection in 28.5% of patients, chemotherapy (28.6%), radiotherapy (17.1%) and palliative care (20.0%). Over the last five years, there were increasing trends in the number of cases discussed in the multidisciplinary team and the number for whom the multidisciplinary management decisions were implemented. The majority (n = 18, 51.4%) of the children with brain tumors were alive and active in care, 34.2% abandoned treatment/lost to follow-up, and 8.6% died. The relative distribution of pediatric brain tumors types in Uganda Cancer Institute differs slightly from international reports, and there has been a notable increase in the number of cases over the years. Implementing multidisciplinary management decisions benefited patients and decreased abandonment and patient loss to follow-up.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"267-280"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9285762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the baseline survival outcomes of the \"six Global Initiative for Childhood Cancer index cancers\" in Africa.","authors":"Jaques van Heerden,&nbsp;Joyce Balagadde-Kambugu,&nbsp;Racheal Angom,&nbsp;Rebecca Claire Lusobya,&nbsp;Guillermo Chantada,&nbsp;Laurence Desjardins,&nbsp;Ido Didi Fabian,&nbsp;Trijn Israels,&nbsp;Vivian Paintsil,&nbsp;Laila Hessissen,&nbsp;Mame Ndella Diouf,&nbsp;Moatasem Elayadi,&nbsp;Suzanne D Turner,&nbsp;Francine Kouya,&nbsp;Jennifer A Geel","doi":"10.1080/08880018.2022.2140860","DOIUrl":"https://doi.org/10.1080/08880018.2022.2140860","url":null,"abstract":"<p><p>Limited survival data for the six Global Initiative for Childhood Cancer (GICC) priority cancers are available in Africa. Management of pediatric malignancies in Africa is challenging due to lack of resources, setting-specific comorbidities, high rates of late presentation and treatment abandonment. Reporting of outcome data is problematic due to the lack of registries. With the aim of evaluating the feasibility of baseline outcomes for the six index cancers, we present a descriptive analysis of respective survival rates in Africa. The survival rates were between 18% (lower middle-income countries) to 82.3% (upper middle-income countries) for acute lymphoblastic leukemia, between 26.9% (low-income countries) to 77.9% (upper middle-income countries) for nephroblastoma, between 23% (low-income countries) to 100% (upper middle-income countries), for retinoblastoma, 45% (low-income countries) to 95% (upper middle-income countries) for Hodgkin lymphoma and 28% (low-income countries) to 76% (upper middle-income countries) for Burkitt lymphoma. Solutions to improve survival rates and reported outcomes include establishing and funding sustainable registries, training and to actively include all countries in consortia from different African regions.HighlightsContinental differences in childhood cancer management such lack of resources, setting-specific comorbidities, high rates of late presentation and treatment abandonment, present challenges to the achievement of Global Initiative for Childhood Cancer goals.The available data registries do not adequately inform on the true incidences and outcomes of childhood cancers in Africa.The pathophysiology of some childhood cancers in Africa are associated with high-risk prognostic factors.Outcomes can be improved by greater regional collaboration to manage childhood cancer based on local resources and tumor characteristics.Some individual countries have reached the Global Initiative for Childhood Cancer goals for single cancers and it should be possible for more African countries to follow suit.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"203-223"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9230855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SACCSG HL-2018. Barriers and enablers of a harmonized treatment protocol for childhood and adolescent Hodgkin lymphoma in South Africa.","authors":"Jennifer Geel,&nbsp;Marc Hendricks,&nbsp;Yasmin Goga,&nbsp;Beverley Neethling,&nbsp;Vutshilo Netshituni,&nbsp;Rema Mathew,&nbsp;Johani Vermeulen,&nbsp;Anel van Zyl,&nbsp;Fareed Omar,&nbsp;Jan du Plessis,&nbsp;Liezl du Plessis,&nbsp;Elelwani Madzhia,&nbsp;Thandeka Ngcana,&nbsp;Thanushree Naidoo,&nbsp;Lizette Louw,&nbsp;Daynia E Ballot,&nbsp;Monika L Metzger","doi":"10.1080/08880018.2022.2162651","DOIUrl":"https://doi.org/10.1080/08880018.2022.2162651","url":null,"abstract":"<p><p><b>Introduction:</b> Collaborative studies have contributed to improved survival of pediatric Hodgkin lymphoma in well-resourced settings, but few are documented in resource-constrained countries. The South Africa Children's Cancer Study Group initiated harmonization of management protocols in 2015. This article analyzes barriers and enablers of the process. <b>Methods:</b> Clinician-researchers at 11 state-funded pediatric oncology units completed preparatory questionnaires in June 2018. Parameters included infrastructure, access to therapeutic modalities and clinician numbers. A reassessment of 13 sites (two new pediatric oncology unit) in February 2021 ascertained changes in resources and identified challenges to full participation. Questions investigated the presence and quality of diagnostic radiology, availability of surgeons, cytology/pathology options and hematology laboratory facilities. <b>Results:</b> The response rate was 11/11 to survey 1 and 13/13 to survey 2. The anticipated pre-study barriers to participation of pediatric oncology units included time constraints and understaffing. PET-CT was unavailable to two centers. The majority of pediatric oncology units met the minimum criteria to participate. The interim survey confirmed chemotherapy and radiotherapy availability nearly 100% of the time. One site reported improved access to radiotherapy while another reported improved access to PET-CT. Barriers to participation included excessive times to obtain regulatory approvals, time constraints and lack of dedicated research staff. Enablers include the simple management algorithm and communication tools. <b>Conclusion:</b> This study demonstrates that multicenter collaboration and harmonization of management protocols are achievable in a middle-income setting. Minimal funding is required but full participation to run high-quality studies requires more financial investment. Focused funding and increased prioritization of research may address systemic barriers to full participation.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"300-313"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9238128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current status of African pediatric oncology education efforts aligned with the Global Initiative for Childhood Cancer.","authors":"Jaques van Heerden, Irumba Lisa Christine, Julia Downing, Alan Davidson, Laila Hessissen, Judy Schoeman, Elena J Ladas, Hafeez Abdelhafeez, Shauna Georgia Odongo Arao, Atalay Mulu Fentie, Sherif Kamal, Jeannette Parkes, Thurandrie Naiker, Adri Ludick, Joyce Balagadde-Kambugu, Jennifer Geel","doi":"10.1080/08880018.2022.2117882","DOIUrl":"10.1080/08880018.2022.2117882","url":null,"abstract":"<p><p>Education of the pediatric oncology workforce is an important pillar of the World Health Organization CureAll technical package. This is not only limited to healthcare workers, but all stakeholders in the childhood cancer management process. It includes governmental structures, academic institutions, parents and communities. This review evaluated the current educational and advocacy training resources available to the childhood cancer community, the contribution of SIOP Africa in the continental educational needs and evaluated future needs to improve the management of pediatric malignancies in reaching the Global Initiative for Childhood Cancer goals. Childhood cancer, unlike adult cancers, has not been prioritized in African cancer control plans nor the teaching and advocacy surrounding pediatric oncology. The availability of formal training programs for pediatric oncologists, pediatric surgeons and radiotherapy specialists are limited to particular countries. In pharmacy and nutritional services, the exposure to pediatric oncology is limited while training in advocacy doesn't exist. Many nonacademic stakeholders are creating the opportunities in Africa to gain experience and train in these various fields, but formal training programs should still be advocated for. LEARNING POINTSThe African continent has various resources to increase the capacity of childhood cancer care stakeholders to increase their knowledge.African pediatric oncology teams rely on a multitude of international sources for training while developing their own.There is a greater need for formal, standardized cancer training especially for pediatric surgeons, radio-oncologists and nurses.Greater inclusion of pathologists, pediatric oncology pharmacists and dieticians into multidisciplinary care and childhood cancer training should be facilitated and resourced.Successful advocacy programs and tool kits exist in parts of Africa, but the training in advocacy is still underdeveloped.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"224-241"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9306428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The pre-surgical factors that determine the decision to proceed to resection in children diagnosed with high-risk neuroblastoma in a resource limited setting.","authors":"Jaques van Heerden,&nbsp;Mariana Kruger,&nbsp;Tonya Marianne Esterhuizen,&nbsp;Anel van Zyl,&nbsp;Marc Hendricks,&nbsp;Sharon Cox,&nbsp;Hansraj Mangray,&nbsp;Janet Poole,&nbsp;Gita Naidu,&nbsp;Ané Büchner,&nbsp;Mariza de Villiers,&nbsp;Jan du Plessis,&nbsp;Barry van Emmenes,&nbsp;Elmarie Matthews,&nbsp;Yashoda Manickchund,&nbsp;Derek Stanley Harrison","doi":"10.1080/08880018.2022.2137610","DOIUrl":"https://doi.org/10.1080/08880018.2022.2137610","url":null,"abstract":"<p><p>Surgical control has prognostic value in neuroblastoma (NB). Advanced NB is common at diagnosis in South Africa. We investigated the pre-surgery factors that influenced decisions to perform surgical resections. We included 204 patients with high-risk NB from a national retrospective study, who completed induction chemotherapy between 2000 and 2016.The median age was 32.4 months (IQR 15.1 - 53.5 months). Primary tumor resection was achieved in 76.9% of patients between 0-18 months of age, 51.8% between 18-60 months and 51.7% older than 60 months (p < 0.001). Only 43.2% of patients with distant metastatic disease had surgery done (p < 0.001). LDH was >750 U/L in 46.8% and ferritin >120 g/dL in 53.1% of those who had surgery (p = 0.005). The majority (80.4%), who had achieved post-induction metastatic complete remission (mCR), were operated, while 28.7% without mCR had surgery (p < 0.001). The long-term overall survival in patients with mCR and primary tumor resection was 36.5% compared to those with mCR without primary tumor resection (25.4%) and without mCR (≤3.0%)(p < 0.001). Age (p < 0.001), stage (p < 0.001), mCR (p < 0.001) and treatment setting (p < 0.001) were of prognostic significance. The tumor site and MYCN-amplification did not significantly predict resection rates. Post-induction mCR and stage were associated with surgical resection and five-year OS (p < 0.001) on multivariate analysis.Patients with high-risk NB who achieved mCR and had primary tumor resections are curable in limited resourced settings. Stage and post-induction mCR were significant variables that led to surgery. These variables should be included as indications in the management of metastatic NB in resource limited settings.</p>","PeriodicalId":19746,"journal":{"name":"Pediatric Hematology and Oncology","volume":"40 3","pages":"242-257"},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9237109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}