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Year : 2018  |  Volume : 14  |  Issue : 11  |  Page : 893-894

Paediatric Oncology

Date of Web Publication29-Nov-2018

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How to cite this article:
. Paediatric Oncology. J Can Res Ther 2018;14, Suppl S4:893-4

How to cite this URL:
. Paediatric Oncology. J Can Res Ther [serial online] 2018 [cited 2022 Oct 2];14, Suppl S4:893-4. Available from: https://www.cancerjournal.net/text.asp?2018/14/11/893/246380

 > Pediatrics: 01 Top

Does surgery to radiotherapy interval affect outcome in Wilms tumour?

Sherry S. Abraham, Sunitha Susan Varghese, S. Patricia, B. Rajesh, B. Selvamani

Department of Radiation Oncology, IDA B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, India

Background: Wilms Tumour(WT) accounts for >90% of pediatric malignancies. Most children with WT present with an asymptomatic palpable mass found by a parent or physician. Upto 20% of children present with hypertension, hematuria, fever and/or flank pain and rarely with acute abdomen secondary to tumour rupture and uncontrolled bleeding. With the use of modern multimodality treatment including chemotherapy, surgery and radiation therapy, the overall survival(OS) for WT approaches 100% for favourable histology and early stage disease. With unfavourable histology or metastatic disease the survival still remains poor. The delay in initiating radiotherapy is considered one of the factors affecting disease free survival(DFS) in NWTS studies 1 and 2. Aims and Objectives: To analyse the clinical profile and treatment outcomes in patients with WT who received radiotherapy in our centre from November 2009 to December 2017 and to correlate if surgery to radiotherapy interval affected outcome. Materials and Methods: A review of hospital medical records was done and we identified 26 patients with Wilms Tumour who received radiation therapy in our hospital between 2009 and 2017. Data on demographic profile, stage at presentation, treatment received and disease outcome was collected. The surgery to radiation therapy interval(SRI) and disease free survival (DFS) were estimated. Univariate analysis was done to find the effect of SRI and stage at presentation on DFS. Results: Of the 26 patients, 14(54%) were males and 12(46%) were females and the median age was 6.5(range 5.4 to 8.5)years. 2(7.7%) patients each had stage I and II disease. 12(46.2%), 8(30.8%) and 1(3.8%) patients had stage III, IV and V respectively. Initial stage was unknown for 1(3.8%) patient. Based on SIOP risk stratification, 30.8%(8 patients) 61.5%(16 patients) and 3.8%(1 patient) had low, intermediate and high risk respectively. Histology was unknown for one patient. 2 patients had SRI of <10 days and ≥ 10 days was for 22 patients. Median follow up period was 12(range 0.3 to 113.5) months. Two(7.6%) patients were lost to follow up. Median DFS of the 24 patients was 12.45(range 1 to 117.5) months. Median DFS was 12.2 (range 0.6 to 76.5) months and 16.9(range 1 to 57.2) months for stage III and stage IV patients respectively. Median SRI was 24.5(range 3 to 41) days. Of the 5 patients who had recurrence, one patient had SRI < 10 days and 4 patients had SRI ≥10 days. Median DFS was 22.1 months and 12.45 months for patients with SRI < 10 days and ≥10 days respectively. There was no significant association for DFS with stage and SRI (p values 0.07, 0.26 respectively). Conclusion: The rate of recurrence in this study population was very low in line with the literature. Early initiation of radiotherapy remains a critical component in the multimodality treatment of patients with non metastatic WT. In this population delay beyond 10 days showed a trend towards increase in recurrence.

 > Pediatrics: 02 Top

Patterns of care in retinoblastoma and analysis of contributory factors – lessons learned from 5 years' experience in a tertiary care center in eastern India

Debjit Ghosh, Bidyut Mondal, Abhishek Basu, Shubhendu Gangopadhyay, Janmenjay Mondal

Regional Institute of Ophthalmology and Department of Radiation Oncology, Medical College and Hospital, Kolkata, West Bengal, India

Aims: Retinoblastoma is the most common intraocular malignancy afflicting children worldwide. Even though there are enough data about the epidemiology of retinoblastoma in western population, there are only few reports from developing countries like India. In this retrospective study, we aimed to describe the epidemiological patterns, survival characteristics and prognostic factors of 68 retinoblastoma cases diagnosed at the Regional Institute of Ophthalmology, Kolkata and treated in conjunction with Department of Radiation Oncology, Medical College & Hospital, Kolkata from 2013 to 2017. Materials and Methods: From medical records, we retrospectively analyzed the data of 68 consecutive children diagnosed in our hospital between January 2013 and December 2017 as having retinoblastoma. Data on sex, religion, laterality, age at diagnosis, presenting signs, family history, lag time for treatment, cause of such lag time and spread of tumor, treatment mode, and survival time were collected. Results: Males (52.9%) slightly exceeded females (47.1%) in incidence. 79.4% of the cases were unilateral and 20.6% of the cases were bilateral. There were 3 cases (4.4%) of trilateral retinoblastoma. While assessing social background, majority (38.2%) were Muslims, followed by Hindus (33.8%). Surprisingly, among others, 25% patients comprised of exclusively Santhal community of tribal population. The median patient age at the onset of symptoms was 22 months. The mean lag time before treatment was 9.37 months. The most presenting signs were leukocoria (44.1%), proptosis (14.3%), diminished vision (13.2%) and redness of and tearing eye (11.8%). Only 4 of 68 cases (5.9%) were familial. The most common known poor prognostic factor included post-op transection involvement of optic nerve (20 cases, i.e. 29.4%) and choroidal invasion (8 cases, i.e., 11.8%). None of the patients developed a secondary neoplasm. The 5-year overall survival rate was 54.4% (unilateral, 68.5%; bilateral, 28.6%). The survival rate of patients with an interval between onset and treatment of <6 months was 68.4%, and that for an interval of >6 months was 36.6%. The survival rate of patients with absence and presence of known poor prognostic factors 83.3% and 44%, respectively. Lag time before treatment initiation was an independent factor indicating a poor prognosis, determined by multivariate analysis. Parents following alternative medicine and initially refusing treatment to avert conventional treatment related risks were among the major causes for such delays in treatment initiation. Conclusions: Muslims and representatives of Santhal community belonging to the tribal population showed the highest incidence. However, familial nature or consanguineous marriages as a causal factor could not be established. The mortality rate of patients with retinoblastoma is higher in our study than in developed countries. The proportion of patients' parents initially refusing or delaying treatment is high. The factors for a poor prognosis were an interval between onset and treatment of 6 months and presence of known poor prognostic factors.

 > Pediatrics: 03 Top

Retrospective analysis of Wilms tumor: 30 year experience at a single institute

Saurabh Manohar Meshram, K. M. Kamble, Ashok Diwan

Department of Radiation Oncology, GMCH, Nagpur, Maharashtra, India

Aims/Objectives: (1) To study 5 yr& 10 yr overall survival & disease free survival. (2) clinicopathologic profile. Materials and Methods: Total 104 clinicoradiologically&histopathologicallyproven patients were registered of which 67were evaluable. Age & sex distribution, mode of prsentation, tumorstage, histopahologic results, median follow up, mean time of relapse after surgery overall survival and disease free survival were evaluated. Results: total 104 patients of which 53 were males (50.96%) and 51 were females (49.03%) with mean age at the time of diagnosis 4.4±0.84yrs. most common presenting symptom were abdominal mass39% followed by abdominal pain25%. Left kidney affected in 52% & right kidney affected in 47%. One patient presented with b/l kidney involvement Radical Nephrectomy was performed in 62% of cases, 25% were metastatic & 13% came in locally advanced stage with poor general condition at the time of presentation. Favourable histology findings were found in 24 (57.14%) and unfavourable were 18 (42.85%). Stage I 7 (10.44%), stage II 5(7.46%), stage III 38 (56.71%), stage IV 17(25.37%), stage V 1 (1.47%), median range of follow up 1.6 yrs (1month-11 yrs), mean time to relapse after surgery 1.67±2.21 yrs. mostcommon site of metastasis were lung 15% f/b liver 10%. 5 yr overall survival rate stage I 87% stage II 84% stage III 75% stage IV 20%, the 5 yr overall survival rate is 74.25%. 10yr survival rate in stage I 62%, stage II 56%, stage III 30%, stage IV 10%, the 10 yr overall survival rate is 39.4%. 5 yr &10 yr event free survival is 69% & 20 %. Conclusion: The childrens who presented at our institute came in late stages, most common presentation in stage III followed by stage IV, the 5 yr& 10 yr survival rate& event free survival rate is very low compared to the other studies. because the presentation of patients in late stages and poor general condition causes difficulty to deliver the optimum treatment. Also other causes like poor socioeconomic status, inability to comply with treatment, inabailty to afford travel expensesand reach centres offering cancer treatment, lack of knowledge about the excellent prognosis with this cancer cannot be ignored.


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