Volume 71, Issue 11 e31300
SPECIAL REPORT

Effectiveness of a Wilms tumour treatment guideline adapted to local circumstances in sub-Saharan Africa: A report from Wilms Africa Phase II—CANCaRe Africa

Diriba Fufa

Diriba Fufa

Pediatrics and Child Health, Jimma University, Jimma, Ethiopia

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Cecilia Mdoka

Cecilia Mdoka

CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research, Blantyre, Malawi

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Mulugeta Ayalew

Mulugeta Ayalew

Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia

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Harriet Khofi

Harriet Khofi

CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research, Blantyre, Malawi

Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi

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Emmanuel Amankwah

Emmanuel Amankwah

Child Health, Korle-Bu teaching Hospital Accra, Accra, Ghana

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Nester Chokwenda

Nester Chokwenda

College of Health Sciences, Child and Adolescent Health, University of Zimbabwe, Harare, Zimbabwe

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Esubalew Mezgebu

Esubalew Mezgebu

Pediatrics and Child Health, Jimma University, Jimma, Ethiopia

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Annelies M. C. Mavinkurve-Groothuis

Annelies M. C. Mavinkurve-Groothuis

Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands

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Steve Kamiza

Steve Kamiza

Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi

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Beatrice Chikaphonya-Phiri

Beatrice Chikaphonya-Phiri

Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi

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Mulugeta Wassie

Mulugeta Wassie

Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia

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Barnabas Atwiine

Barnabas Atwiine

Mbarara University of Science and Technology, Mbarara, Uganda

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Mushabe Branchard

Mushabe Branchard

Mbarara University of Science and Technology, Mbarara, Uganda

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Maite Gorostegui

Maite Gorostegui

Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain

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Jeannette Parkes

Jeannette Parkes

Radiotherapy, Red Cross-South Africa, Cape Town, South Africa

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Evaristar Kudowa

Evaristar Kudowa

Department of Statistics, Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi

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Bernice Eklu

Bernice Eklu

Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

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Brian Jator

Brian Jator

Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon

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Lorna Awo Renner

Lorna Awo Renner

Child Health, Korle-Bu teaching Hospital Accra, Accra, Ghana

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Eric Borgstein

Eric Borgstein

Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi

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Elizabeth Molyneux

Elizabeth Molyneux

Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi

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Francine Kouya

Francine Kouya

Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon

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Kathy Pritchard-Jones

Kathy Pritchard-Jones

University College London, London, UK

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Vivian Paintsil

Vivian Paintsil

Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

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Inam Chitsike

Inam Chitsike

College of Health Sciences, Child and Adolescent Health, University of Zimbabwe, Harare, Zimbabwe

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George Chagaluka

George Chagaluka

Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi

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Trijn Israels

Corresponding Author

Trijn Israels

CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research, Blantyre, Malawi

Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi

Correspondence

Trijn Israels, Department of Paediatrics, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi.

Email: [email protected]

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First published: 28 August 2024
Citations: 2

Abstract

Background

Wilms tumour (WT) is one of the cancer types targeted by the Global Initiative for Childhood Cancer (GICC). The objective of this study was to describe the outcomes of Wilms Africa Phase II in sub-Saharan Africa.

Methods

Wilms Africa Phase II used a comprehensive WT treatment protocol in a multi-centre, prospective study conducted in eight hospitals in Ethiopia (2), Ghana (2), Malawi, Cameroon, Zimbabwe and Uganda. Eligibility criteria were: age younger than 16 years, unilateral WT, diagnosed between 1 January 2021 and 31 December 2022.

Results

We included 230 WT patients, median age 3 years, 53% male. Median maximum tumour diameter at diagnosis was 13.6 cm and 33% of patients had metastatic disease. Nephrectomy was performed in 71% of patients, of whom 21% had a tumour rupture. Two-year event-free survival (EFS) was 41.3% ± 3.9% after a median follow-up of 17 months (range: 1–33 months), with treatment abandonment considered an event. Treatment abandonment occurred in 26% and death during treatment in 14%. Disease relapse occurred in 10%. Two-year EFS of the 26 patients who received radiotherapy was 64.5% ± 9.7% with no reported disease relapse.

Conclusion

Patients continue to present late with advanced WT in sub-Saharan Africa, and their survival is below the 60% GICC target. Prevention of treatment abandonment and treatment-related mortality remain important. Earlier diagnosis and access to radiotherapy are expected to decrease disease-related mortality.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflicts of interest.

DATA AVAILABILITY STATEMENT

Data available on request from the authors.

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