Welcome to SIOP 2022 Interactive Programme
The Congress will officially run on CET time zone (Central European Time, Barcelona)
665 Presentations
HOW I TREAT EPENDYMOMA (FROM BASICS TO LATEST MOLECULAR FINDINGS)
- John-Paul Kilday (United Kingdom)
HOW I TREAT MEDULLOBLASTOMA (FROM BASICS TO LATEST MOLECULAR FINDINGS)
- Vijay Ramaswamy (Canada)
HOW I TREAT LOW GRADE GLIOMAS (FROM BASICS TO LATEST MOLECULAR FINDINGS)
- Eric Bouffet (Canada)
Q&A
ADDRESSING THE GAP IN RESEARCH METHODOLOGIES EDUCATION IN PEDIATRIC ONCOLOGY IN THE EASTERN MEDITERRANEAN REGION
- Raya Saab (Lebanon)
Abstract
Background and Aims
Formal training in research methodologies is limited in LMICs. The Pediatric Oncology East & Mediterranean Group (POEM) and St. Jude Global developed a workshop focused on capacity building in research skills. We describe its structure, implementation, and early results.
Methods
Leveraging virtual capabilities, lectures and small group ‘breakout’ exercise sessions were conducted for 3 hours per day on 2 consecutive days over 2 weeks, at 15:00-18:00 GMT to accommodate time zones. Topics included research design, data registries, healthcare statistics, research ethics, and scientific writing. Each applicant submitted a research study abstract. Breakout groups selected one abstract each for further development, which they subsequently presented in a groupwide session. Feedback was captured through an online survey.
Results
Attendance included 29 registrants from 12 countries and 6 disciplines (17 physicians, 6 research staff, 2 nurses, 4 other). Final output presentations included a retrospective, a prospective observational, a prospective interventional, and a registry study proposal. After the workshop, participants were invited to further develop their original abstracts and 3 received additional mentoring. The post-workshop survey was filled by 100% of attendees, with a score of “excellent” or “very good” given by 84% on overall quality, 87% on platform suitability, and 72% on course length. Course objectives were deemed met by 79-94% of participants, by specific session. At least 25% of the material was new for 93%, and more than 50% was new for 51%. All attendees felt that the material will impact their practice. Group discussions were highlighted by 73% as being a most effective aspect. The top 3 voted themes for future workshops were statistical analysis (64%), writing & publishing (45%), and quality improvement (39%).
Conclusions
This workshop demonstrates the potential for HIC-LMIC network partnerships in targeting research training gaps. Lessons learned will be applied to the planning of future workshops to strengthen research in LMICs.
SOCIOECONOMIC STATUS HAS NO LONGER IMPACT ON OS AND EFS OF CHILDHOOD ALL IN YOGYAKARTA, INDONESIA AFTER INTRODUCTION OF UNIVERSAL HEALTH CARE ACT
- Claudia P. Adelin (Indonesia)
Abstract
Background and Aims
About 60% of our patients come from low socioeconomic status (SES). Our previous study showed that low SES negatively affected the outcome of children with ALL. This study aimed to re-examine whether SES influences the outcome of treatment in children with ALL after the implementation of the Universal Health Care Act (UHC).
Methods
Since February 2013 until November 2018, 362 children with ALL were registered in Sardjito General Hospital Yogyakarta, 174 using ALL2013 protocol and 188 using ALL2016 protocol. They were divided into two groups: low SES and higher SES. Families with a monthly income of less than 2.5 million IDR (approximately US 5 a day) or treated in third class ward were labeled low SES. The 4-year pOS and pEFS were analyzed using Kaplan Meier method.
Results
Among 362 children, 241 (66.6%) come from low SES families. The 4-year-pOS of the low SES and the higher SES in ALL2013 were 48.4% and 54.2% respectively (P= 0.346) and in ALL2016 59.1% and 61.6% (P= 0.504). The 4-year-pEFS of the low SES and the higher SES in ALL2013 were 34.9% and 41.7% (P= 0.305), and in ALL2016 48.7% and 50.7% (p=0.668). The number of abandonments decreased significantly compared to our previous study (35% in 2006, 11.5% in ALL2013; P<0.001, and 5.9% in ALL2016; P<0.001). After the implementation of UHC, more people from lower SES could access health facilities and were less hindered by financial problems.
Conclusions
After free access to healthcare facilities, economic factors seemed to no longer significantly affect the outcome of children with ALL.
MULTI-CENTER, PHASE 3, RANDOMIZED CONTROLLED TRIAL, COMPARING DAUNORUBICIN AND ARAC (DA) VERSUS ARAC, DAUNORUBICIN, AND ETOPOSIDE (ADE) INDUCTION CHEMOTHERAPY IN PEDIATRIC ACUTE MYELOID LEUKEMIA (INPOG-AML-01-14).
- Venkatraman Radhakrishnan (India)
Abstract
Background and Aims
The benefit of three-drug induction chemotherapy over a two-drug induction has not been evaluated in pediatric acute myeloid leukemia (AML). We, therefore, conducted a multi-center, open-label, investigator-initiated phase III randomized controlled trial to ascertain the benefit of a three-drug induction regimen in pediatric AML.
Methods
Patients aged between 1-18 years with newly diagnosed AML were recruited in the study between 22nd May 2014 and 14th November 2019 across three sites in India. They were randomized to two cycles of induction chemotherapy with daunorubicin and ara-C (DA) or two cycles of ara-C, daunorubicin, and etoposide (ADE). After completing the induction, patients in both arms received consolidation with two cycles of high-dose ara-C. The study's primary objective was to compare the event-free survival (EFS) between the two arms. The secondary objectives were to compare the complete-remission (CR) rates, overall survival (OS), and toxicities.
Results
The study randomized 149 patients, 77 patients in the DA and 72 in the ADE arm. The median age was 8.7 years, and 92 (62%) patients were males. The median follow-up was 50.9 months. After the first induction, the CR rate in the DA and ADE arm were 65% and 68% (P=0.68), respectively, while it was 82% and 79% (P=0.68) after the second induction. There were 13 (17%) induction deaths in the DA arm, of which nine were treatment-related, and 12 (17%) in the ADE arm, of which seven were treatment-related (P=0.97). Forty patients relapsed in DA arm and 37 in ADE (P=0.94). The 5-year EFS in the DA and ADE arm was 34.5% and 34.5%, respectively (P=0.66). The 5-year OS in the DA and ADE arm was 41.4% and 42.1%, respectively (P=0.77). There were no significant differences in toxicities between the regimens.
Conclusions
ADE induction regimen did not improve EFS, OS, and CR in pediatric AML compared to DA regimen.
PEDCAN: ACCEPTABILITY AND FEASIBILITY OF A MOBILE APPLICATION BY PRIMARY HEALTH-CARE WORKERS TO RECOGNIZE CHILDREN WITH CANCER IN UGANDA
- Barnabas Atwiine (Uganda)
Abstract
Background and Aims
Early diagnosis of cancer in children is dependent on a high index of suspicion and referral by primary health care workers (PHCW) to cancer specialists at tertiary centres. The aim of this study was to assess the acceptability and feasibility of PEDCan mobile application by primary health care workers to recognize children with cancer-related clinical features, initiate remote consultations with specialists and refer them timely for diagnosis.
Methods
We developed a mobile application, called PEDCan, to aid PHCWs recognize children with cancer, hold remote consultations with specialists and refer them to cancer centres. In May 2021, we conducted a cross-sectional descriptive study among consented PHCWs in southwest Uganda to collect data about knowledge regarding childhood cancer, smart phone ownership and internet usage. After training them on the use of the application using mock clinical scenarios, their ease and readiness to use it was assessed. Descriptive statistics were used to calculate proportions of participants able and willing to use it. Ethical approval was provided by Research and Ethics Committee of Mbarara University of Science and Technology
Results
Forty-four PHCWs participated in the study. Twenty-five (56.8%) were nurses/midwives, 8 (18.2%) clinical officers, 3 (6.8%) general doctors and 8 (18.2%) other cadres. All had heard about childhood cancer and 28 (63.6%) had ever seen a child suspected to have cancer. Thirty-eight (86.4%) participants owned a smart phone and used internet and 12 (31.6%) had access to internet all the time. Thirty-eight (86.3%) participants found the use of PEDCan very easy or easy and all were willing to use it.
Conclusions
PHCWs were able and willing to use PEDCan application to recognize children with cancer and initiate remote expert consultations. A pilot study with real patients would further demonstrate effectiveness in real life clinical settings.
WELCOME
- Simone D. Abib (Brazil)
OPTIMAL TREATMENT STRATEGIES FOR HEPATOBLASTOMA WITH ADVANCED PRETEXT STAGE
- Kyung-Nam Koh (Korea, Republic of)
Abstract
Background and Aims
The advances in surgical techniques and risk-stratified chemotherapy have improved the survival rate of hepatoblastoma (HB) to over 80%. However, in patients with advanced HB, the survival outcomes remain approximately 50-60%. Therefore further optimization of treatment strategies in advanced HB is imperative to improve outcomes.
Methods
We retrospectively reviewed the medical records of 44 patients with HB ≥ PRETEXT stage Ⅲ. We evaluated overall survival (OS), event-free survival (EFS), and transplant-free survival (TFS) in association with prognostic factors including pre-treatment extent of tumor (PRETEXT) stage, post-treatment extent of tumor (POSTTEXT) stage with their annotation factors, and newly defined Children’s Hepatic tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system.
Results
OF the 44 patients, 27 (61%) were PRETEXT 3. Fifteen (34%) had metastasis at diagnosis: all were lung metastasis. Except for 3 patients, one who received upfront surgery and 2 who died before surgery, 41 received surgery after a median 6 cycles of chemotherapy (range, 3-15): 22 received hepatectomy, and 19 received LT. The 5-year OS, EFS, and TFS were 87%, 77%, and 43%. The known prognostic factors including PRETEXT, POSTTEXT, and annotations did not affect the OS and EFS, while patients who received LT had better outcomes than those who received hepatectomy (5-year OS and EFS of 100% and 90% vs. 82% and 73%, P<0.05). Otherwise, in the analysis of TFS, the PRETEXT and POSTTEXT were significant. Among the annotation factors, P and F affected the TFS, while M did not affect it.
Conclusions
Our study represented LT as a valuable modality to overcome poor prognostic factors in the treatment of advanced HB. Further refinement of surgical strategies, including LT indications based on a careful review of PRETEXT and POSTTEXT with annotations, is needed to improve the outcomes.
SURGICAL MANAGEMENT OF PRETEXT III-IV HEPATOBLASTOMA: COMPARISON OF OUTCOMES AFTER PRIMARY TRANSPLANT, RESCUE TRANSPLANT AND LIVER RESECTION
- Caroline P. Lemoine (United States of America)
Abstract
Background and Aims
Liver transplantation for hepatoblastoma (HPB) is indicated for patients with unresectable tumor (PRETEXT III-IV) either primary or recurrent. Rescue transplants for recurrence have been associated with worse outcomes. We aim to present a single institutional experience with resection for PRETEXT III-IV tumors and compare outcomes to those after liver transplantation for HPB.
Methods
A review of patients operated for PRETEXT III-IV HPB (including hepatocellular neoplasm, not otherwise specified, HCN-NOS) at a single national pediatric hepatobiliary referral center was performed (1997-2021). We compared outcomes among 3 groups: resection alone (G1), resection followed by rescue transplant (G2), and primary transplant (G3). p<0.05 was considered significant.
Results
Sixty-three patients presented with PRETEXT III-IV HPB (including 9 patients with HCN-NOS tumor): 45 underwent primary resection of which 4 recurred. Seven patients received a rescue transplant including 2 who were referred with recurrent tumor after being initially treated and resected at another institution. Sixteen patients received a primary transplant. Comparing transplant groups (G3 and G2), the 5-year event free survival (EFS) and overall patient survival (OS) were superior in G3 vs G2 (5-yr EFS: 93.8% vs. 42.9%, p<0.001; OS G3 100.0% vs. G2 57.1%, p=0.006). Post-transplant tumor recurrence was more frequent in rescue transplants (G3 57.1% vs. G2 6.3%, p=0.006). Of patients with HCN-NOS, 3/3 patients who received a primary transplant had EFS in contrast to only 3/6 after a primary resection (p=0.13). Overall, mortality from recurrent disease was similar between G3 group and all patients who underwent a resection as primary treatment (G3 0.0% vs. G1+G2 12.8%, p=0.13).
Conclusions
Rescue transplant for hepatoblastoma has improved from previous reports but remains challenging. Primary transplant and resection alone for PRETEXT III and IV hepatoblastoma both offer similar excellent survival. Patients with HCN-NOS have worst outcomes and would benefit from early referral to centers of excellence and aggressive initial management including primary transplantation.
PROGNOSTIC FACTORS AND TREATMENT OUTCOMES IN PRIMITIVE NEUROECTODERMAL TUMOURS OF THE SPINE: A SINGLE CENTRE ANALYSIS OF 83 PATIENTS
- Archana Sasi (India)
Abstract
Background and Aims
Primitive neuroectodermal tumours (PNETs) of the spine are rare childhood cancers with sparse literature on their survival outcomes. We aim to describe the treatment outcomes and prognostic factors in a cohort of patients with spinal PNET treated in a single institution using a uniform treatment protocol over an 18-year period.
Methods
We conducted a single institutional retrospective analysis of patients with PNET of the spine registered at a tertiary care oncology centre between 2003 to 2018. Data pertaining to clinical and demographic characteristics of the patients and treatment outcomes was collected from hospital records. Univariable and multivariable Cox regression analysis was used to identify the association of baseline clinical parameters with event free survival (EFS) and overall survival (OS).
Results
A cohort of 83 patients was analysed including 37 (44.5%) patients with metastatic disease. The median age was 16 years (IQR: 13-19.5 years) with 73% of the patients being male. Nearly 20% of all patients (n=15) had been misdiagnosed to have spinal tuberculosis at presentation and received antitubercular therapy. Local therapy was administered in 60 (72.3%) patients with surgery alone in 8 (9.6%), radiotherapy alone in 17 (20.5%) and both surgery and radiotherapy in 35 (42.2%) patients. The median EFS and OS were 15 months (IQR: 7.7-31 months) and 18 months (IQR 9.4-41.5 months) respectively. On univariable analysis, age above 15 years, haemoglobin (<10 g/dL), serum albumin (<3.5 g/dL) and female gender were found to predict for shorter OS and EFS. Serum albumin (<3.5) remained the only factor predictive for EFS (HR 2.42; p-value 0.005) and OS (HR 2.11; p-value=0.032) on multivariable analysis. Survival outcomes were similar in localised and metastatic disease.
Conclusions
Serum albumin level was the only prognostic factor for event free and overall survival in patients with PNET of the spine.