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. 2019 Sep:5:1-8.
doi: 10.1200/JGO.18.00204.

Treatment of Wilms Tumor in Sub-Saharan Africa: Results of the Second French African Pediatric Oncology Group Study

Atteby Jean-Jacques Yao  1 , Claude Moreira  2 , Fousseyni Traoré  3 , Sonia Kaboret  4 , Angele Pondy  5 , Mbolanirina Lala Rakotomahefa Narison  6 , Koffi M Guedenon  7 , Brenda Mallon  8 , Catherine Patte  8
Affiliations

Treatment of Wilms Tumor in Sub-Saharan Africa: Results of the Second French African Pediatric Oncology Group Study

Atteby Jean-Jacques Yao et al. J Glob Oncol. 2019 Sep.

Abstract

Purpose: Multidisciplinary management of Wilms tumor has been defined through multicenter prospective studies and an average expected patient cure rate of 90%. In sub-Saharan Africa, such studies are uncommon. After the encouraging results of the first Groupe Franco-Africain d'Oncologie Pédiatrique (GFAOP) study, we report the results of the GFAOP-NEPHRO-02 study using an adaptation of the International Society of Paediatric Oncology 2001 protocol.

Patients and methods: From April 1, 2005, to March 31, 2011, seven African units participated in a nonrandomized prospective study. All patients who were referred with a clinical and radiologic diagnosis of renal tumor were screened. Those older than age 6 months and younger than 18 years with a unilateral tumor previously untreated were pre-included and received preoperative chemotherapy. Patients with unfavorable histology or with a tumor other than Wilms, or with a nonresponding stage IV tumor were excluded secondarily.

Results: Three hundred thirteen patients were initially screened. Two hundred fifty-seven patients were pre-included and 169 with histologic confirmation of intermediate-risk nephroblastoma were registered in the study and administered postoperative treatment. Thirty-one percent of patients were classified as stage I, 38% stage II, 24% stage III, and 7% stage IV. Radiotherapy was not available for any stage III patients. Three-year overall survival rate was 72% for all study patients and 73% for those with localized disease.

Conclusion: It was possible to conduct sub-Saharan African multicenter therapeutic studies within the framework of GFAOP. Survival results were satisfactory. Improvements in procedure, data collection, and outcome are expected in a new study. Radiotherapy is needed to reduce the relapse rate in patients with stage III disease.

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Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc.

No potential conflicts of interest were reported.

Figures

FIG 1
FIG 1
Flowchart of registered patients. The 30 pre-/peroperative deaths were a result of treatment-related toxicity (n = 8), tumor progression before any resection (n = 15), during surgery (n = 3), after surgery but without histologically examination (n = 3), and anesthetic accident (n = 1). Diagnosis of the 10 non-Wilms tumor cases excluded postoperatively were clear-cell sarcoma (n = 5), renal carcinoma (n = 2), Burkitt lymphoma (n = 1), neuroblastoma (n = 1), and bilharzia (n = 1). Slides reviewed in four cases confirmed the diagnoses of Burkitt (n = 1) and clear-cell sarcoma (n = 3). Among the 21 high-risk Wilms tumors, review confirmed the diagnosis of blastemal type in two cases and of diffuse anaplastic in two cases.
FIG 2
FIG 2
Outcome of the 158 patients with a nonmetastatic unilateral standard-risk histology Wilms tumor included in the study. Early abandonment is defined as during the 8-week postoperative phase; late abandonment defined as during maintenance treatment. CR1, in first complete remission; FU, follow up; Tt, treatment.
FIG 3
FIG 3
Overall survival (OS) and event-free survival (EFS) curves of the entire study population.
FIG 4
FIG 4
Survival curves of patients with nonmetastatic disease. OS, overall survival; EFS, event-free survival.
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References

    1. Breslow N, Olshan A, Beckwith JB, et al. Epidemiology of Wilms tumor. Med Pediatr Oncol. 1993;21:172–181. - PubMed
    1. Lemerle J, Voûte PA, Tournade MF, et al. Effectiveness of preoperative chemotherapy in Wilms’ tumor: Results of an International Society of Paediatric Oncology (SIOP) clinical trial. J Clin Oncol. 1983;1:604–609. - PubMed
    1. de Kraker J, Lemerle J, Voûte PA, et al. Wilm’s tumor with pulmonary metastases at diagnosis: The significance of primary chemotherapy. J Clin Oncol. 1990;8:1187–1190. - PubMed
    1. Tournade MF, Com-Nougué C, Voûte PA, et al. Results of the Sixth International Society of Pediatric Oncology Wilms’ Tumor Trial and Study: A risk-adapted therapeutic approach in Wilms’ tumor. J Clin Oncol. 1993;11:1014–1023. - PubMed
    1. Tournade MF, Com-Nougué C, de Kraker J, et al. Optimal duration of preoperative therapy in unilateral and nonmetastatic Wilms’ tumor in children older than 6 months: Results of the Ninth International Society of Pediatric Oncology Wilms’ Tumor Trial and Study. J Clin Oncol. 2001;19:488–500. - PubMed

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