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

Autor: Trijn Israels, Dalida Pidini, Huib N. Caron, Jan de Kraker, Steve Kamiza, Liz Molyneux, Eric Borgstein, George Chagaluka
Rok vydání: 2012
Předmět:
Zdroj: Pediatric Blood & Cancer. 59:636-641
ISSN: 1545-5009
Popis: Long term survival of children with Wilms tumour in highincome countries is 85–90% [1,2]. The treatment consists of acombination of chemotherapy, surgery and, in selected cases,radiotherapy. Two treatment strategies have been used worldwide.One is to operate upon tumours upfront as practised by the Child-ren’s Oncology Group (COG) in North America [2]. The other isto start treatment with preoperative chemotherapy as practised inEurope (SIOP studies) [1,3]. Both strategies result in similar long-term survival for patients in high-income countries. However,80% of the children worldwide with cancer live in developingcountries where the situation is different and survival is lower.According to current SIOP treatment protocols, preoperativechemotherapy is given to patients with Wilms tumour to reducesurgical complications, especially tumour rupture, and to downstagethe tumour at surgery thus allowing for less intense post-operativechemotherapy without radiotherapy [1]. This is a logical strategy forMalawian patients who often have large tumours, in a setting wheresupportive care is limited and radiotherapy not available.Patients with Wilms tumour in low-income countries oftenpresent with acute malnutrition. About half of the Malawianpatients in a previous study were severely, acutely malnourished[4,5]. Malnutrition reduces immunity to infections and in patientswith Burkitt lymphoma is associated with more severe chemo-therapy-related toxicity, especially neutropenia [6–8]. Not allaspects of supportive care available in high-income countriesare available to children in Malawi and so it is essential to balanceintensity of treatment with these factors to avoid unacceptabletreatment-related morbidity and mortality.A Wilms tumour treatment guideline was implemented inBlantyre, Malawi that includes preoperative and postoperativechemotherapy, supportive care and social support to enableparents to complete treatment. Feasibility and outcome of thistreatment guideline in the first twenty patients was describedpreviously. A larger number of patients allows for more detailedand specific analyses and conclusions. In this paper we evaluatethe toxicity and efficacy of preoperative chemotherapy.
Databáze: OpenAIRE
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