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
Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
Search for more papers by this authorCecilia Mdoka
CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research, Blantyre, Malawi
Search for more papers by this authorMulugeta Ayalew
Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
Search for more papers by this authorHarriet 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
Search for more papers by this authorEmmanuel Amankwah
Child Health, Korle-Bu teaching Hospital Accra, Accra, Ghana
Search for more papers by this authorNester Chokwenda
College of Health Sciences, Child and Adolescent Health, University of Zimbabwe, Harare, Zimbabwe
Search for more papers by this authorEsubalew Mezgebu
Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
Search for more papers by this authorAnnelies M. C. Mavinkurve-Groothuis
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
Search for more papers by this authorSteve Kamiza
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorBeatrice Chikaphonya-Phiri
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorMulugeta Wassie
Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
Search for more papers by this authorBarnabas Atwiine
Mbarara University of Science and Technology, Mbarara, Uganda
Search for more papers by this authorMushabe Branchard
Mbarara University of Science and Technology, Mbarara, Uganda
Search for more papers by this authorMaite Gorostegui
Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
Search for more papers by this authorJeannette Parkes
Radiotherapy, Red Cross-South Africa, Cape Town, South Africa
Search for more papers by this authorEvaristar Kudowa
Department of Statistics, Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
Search for more papers by this authorBernice Eklu
Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Search for more papers by this authorBrian Jator
Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon
Search for more papers by this authorLorna Awo Renner
Child Health, Korle-Bu teaching Hospital Accra, Accra, Ghana
Search for more papers by this authorEric Borgstein
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorElizabeth Molyneux
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorFrancine Kouya
Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon
Search for more papers by this authorVivian Paintsil
Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Search for more papers by this authorInam Chitsike
College of Health Sciences, Child and Adolescent Health, University of Zimbabwe, Harare, Zimbabwe
Search for more papers by this authorGeorge Chagaluka
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorCorresponding 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]
Search for more papers by this authorDiriba Fufa
Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
Search for more papers by this authorCecilia Mdoka
CANCaRe Africa, The Collaborative African Network for Childhood Cancer Care and Research, Blantyre, Malawi
Search for more papers by this authorMulugeta Ayalew
Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
Search for more papers by this authorHarriet 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
Search for more papers by this authorEmmanuel Amankwah
Child Health, Korle-Bu teaching Hospital Accra, Accra, Ghana
Search for more papers by this authorNester Chokwenda
College of Health Sciences, Child and Adolescent Health, University of Zimbabwe, Harare, Zimbabwe
Search for more papers by this authorEsubalew Mezgebu
Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
Search for more papers by this authorAnnelies M. C. Mavinkurve-Groothuis
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
Search for more papers by this authorSteve Kamiza
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorBeatrice Chikaphonya-Phiri
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorMulugeta Wassie
Unit of Pediatric Hematology Oncology, University of Gondar Specialized Hospital, Gondar, Ethiopia
Search for more papers by this authorBarnabas Atwiine
Mbarara University of Science and Technology, Mbarara, Uganda
Search for more papers by this authorMushabe Branchard
Mbarara University of Science and Technology, Mbarara, Uganda
Search for more papers by this authorMaite Gorostegui
Pediatric Cancer Center Barcelona, Hospital Sant Joan de Déu, Barcelona, Spain
Search for more papers by this authorJeannette Parkes
Radiotherapy, Red Cross-South Africa, Cape Town, South Africa
Search for more papers by this authorEvaristar Kudowa
Department of Statistics, Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
Search for more papers by this authorBernice Eklu
Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Search for more papers by this authorBrian Jator
Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon
Search for more papers by this authorLorna Awo Renner
Child Health, Korle-Bu teaching Hospital Accra, Accra, Ghana
Search for more papers by this authorEric Borgstein
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorElizabeth Molyneux
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorFrancine Kouya
Paediatrics, Mbingo Baptist Hospital, Mbingo, Cameroon
Search for more papers by this authorVivian Paintsil
Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Search for more papers by this authorInam Chitsike
College of Health Sciences, Child and Adolescent Health, University of Zimbabwe, Harare, Zimbabwe
Search for more papers by this authorGeorge Chagaluka
Paediatrics and Child Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
Search for more papers by this authorCorresponding 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]
Search for more papers by this authorAbstract
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.
Open Research
DATA AVAILABILITY STATEMENT
Data available on request from the authors.
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