Survival and Treatment Outcome of Pediatric Soft Tissue and Bone Sarcomas in Tanzania

Abstract

<h3>Purpose/Objective(s)</h3> Pediatric sarcomas are aggressive solid childhood tumors which often present with distant metastatic disease. Muhimbili National Hospital (MNH) treats most of the childhood cancers diagnosed in Tanzania adapting management strategies from established treatment protocols conducted in the Europe. The objective of this study is to describe treatment and overall survival (OS) for pediatric sarcoma treated at MNH. <h3>Materials/Methods</h3> Eligible patients had confirmed histological diagnosis of bone or soft tissue sarcoma treated at MNH between 2011 and 2016. Treatment by stage was documented. Imaging response was assessed as: complete response (CR), partial response (PR), no response (NR); OS was assessed at 2-years. <h3>Results</h3> 135 cases were retrospectively analyzed; 89 (66%) were STS; 46 (34%) were bone sarcomas. 193 treatments were administered including surgery 82 (42.5%), chemotherapy 74 (38.3%), and radiation therapy 11 (8%). A subset of patients received multimodal therapy that included surgery, chemotherapy, and radiation therapy. 26 (13%) palliative care treatments were delivered to those with advanced stage disease. Response rates for STS: 37 (42%) CR, 12 (14%) PR, 38 (43%) NR and for bone sarcoma: 14 (30%) CR, 4 (9%) PR, 28 (61%) NR. 2-year OS for early-stage STS and bone sarcoma was significantly higher at 75% and 90% respectively compared to late-stage disease 21% and 25% (p<0.001). <h3>Conclusion</h3> This is the first report to document treatment and outcome for pediatric sarcomas in Tanzania. We show that early-stage disease is potentially curable while advanced stage disease has significantly worse outcomes. Patents with stage IV disease are likely to receive palliative care only. Future studies are needed to explore reasons for high rates of incomplete treatment with chemotherapy and no radiation therapy in Tanzania.