The Children Hospital Lahore is a tertiary government hospital providing free cancer treatment and receiving over 500 new cancer patients per year. The solid tumors constitute the 50% of the new cases. In our center good prognosis group (Wilm tumor, Hodgkin Lymphoma and extracranial germ cell tumor GCT) fare better than Sarcomas, Neuroblastoma, NHL and Retinoblastoma.
The purpose of this study was to analyze treatment and outcome of children with biopsy proven first group solid tumors and discuss various factors causing poor outcome as compared to developed countries.
Retrospective review of 351 patients (WT 125, Hodgkin 140 and GCT 86) enrolled between January 2011 to May 2014 was done. Data regarding age, stage, histopathology, treatment, outcome and impact of delayed presentation were analyzed.
Total 351 patients with age ranging from < 1 to 15 years (<10 yrs=312/351 - 89%) were included. M: F Ratio was 1.5:1 (211:140). 317/351 (90%) presented with advanced stage, 143/351 (40%) stage IV and 174/351(50%) stage III and only 34/351(10%) had stage II, (p-value=0.014). 36% with Wilm tumor,40% cases of HD, among Hodgkin patients mixed cellularity was the most common. GCT, 24% cases–Yolk sac tumor was the most common type.
Total 199/351 (57%) have completed treatment, 56/351 (16%) are on treatment, 35/351 (10%) got LAMA and 43/351 (12%) expired due to metastatic and progressive disease and complications of therapy. Eleven patients (3%) relapsed during their course of therapy.
Survival of these patients can be significantly improved by strengthening the social support services and public awareness, training doctors and health staff at primary and secondary level for early referrals. Mortality of 12% can be reduced by early diagnosis and treatment and effective infection control practices. The abandonment rate (10%) can be decreased by effective counseling of parents, efficient follow-up services in the day care center.