Radiation Needs In Pediatric Oncology in the Lake Region Of Tanzania

Abstract

Abstract 32 Background: The majority of new pediatric cancer diagnoses are made in resource-poor countries where survival rates range from 5-25%, compared with 80% in high-resource countries. A key component of treatment includes radiation therapy, but access is extremely limited in East Africa. This study estimates the potential clinical benefit of radiation therapy for pediatric oncology patients at Bugando Medical Centre (BMC), a tertiary referral center in the lake zone of Tanzania, one of two cancer treatment centers in Tanzania. Methods: Study design is a retrospective review of recorded hospital admissions and clinic visits to the oncology department at BMC from January 2010-December 2014. The indication for radiation therapy was extrapolated from contemporary SIOP and COG protocols. The benefits of radiotherapy, both for curative and palliative intent, were estimated based on age, diagnosis and stage at presentation by two radiation oncologists. Results: A total of 221 pediatric patients were identified. The most common recorded diagnoses were Burkitt lymphoma (n=36), other non-Hodgkin lymphoma (n=33), Wilms tumor (n=32), acute leukemia (n=28) and retinoblastoma (n=23). Treatment received included chemotherapy only for 163 patients (74%), surgery only for 5 patients (2%), and a combination of chemotherapy and surgery for 30 patients (14%). No patients received radiation therapy due to lack of availability at our center. For 77 patients (35%), staging information was insufficient and the potential benefit of radiation therapy could not be determined. Of the remaining 144 cases, radiation could have been included in the treatment plan for 49 patients (34%, 95% CI 26-42%). Of these, 41 patients (84%, 95% CI 74-94%) could have been treated with curative intent and 8 patients (16%, 95% CI 6-26%) could have benefitted from palliative radiation therapy. Conclusion: Radiation therapy is an essential treatment modality for pediatric cancer but has limited availability in East Africa. In our population, roughly one third of presenting patients would have benefitted from radiation as part of their treatment. Most patients who would benefit from radiation therapy would be treated with curative intent. Introducing radiation has the potential to significantly improve pediatric cancer outcomes in the lake zone of Tanzania. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.