| Title | Coordinators | Country |
|---|---|---|
| Developing a Model of Care for BL in Equatorial Africa | Ian Magrath and Melissa Adde | Uganda and Tanzania |
| Pediatric Oncology Education in Pakistan | Aziza Shad | Pakistan |
| Pediatric Oncology Programme 2016 | Melissa Adde, Sidnei Epelman | Brasil |
| Retinoblastoma in Francophone Africa (2013) | Pierre Bey | Mali, Democratic Republic of Congo, Ivory Coast, Senegal |
| Training of Pediatric Oncologists in Ethiopia | Aziza Shad, Mary Louise Cohen | Ethiopia |
The INCTR Pediatric Program is Coordinated by Dr Sidnei Epelman who is also President of the Brasil Branch. A long standing component of the pediatric program has been the Treatment of Burkitt lymphoma and providing training in early detection, data collection and an improved system for follow-up. The protocol is very simple, consisting of 3 drugs - cyclophosphamide, vincristine and prednisone. Over 800 patients have been treated in African hospitals in Kenya, Uganda, Nigeria (two centers, one in Ile Ife and one in Ibadan) with variable results which appear to depend on the efficiency of the medical care. In East Africa, an attempt to establish an early detection program, and a large number of clinics and district hospitals in the Gulu District in Uganda were established. However, in the last year long absences by the hospital director and less than conscientious data collection has been a major problem. While in the past, it has often been assumed that the main determinant has been the efficacy of treatment, it has become clear that many centers, even with access to all necessary drugs have problems relating to documentation of clinical characteristics and care of patients between treatment cycles. Obtaining chemotherapeutic agents has not been a problem, although the lack of discipline with respect to data collection (obviously incorrect information being provided with little interest on the part of senior doctors). It would seem that cultivating a scientific approach, even of the simplest kind (e.g., case series) is as important as the delivery of therapy. Early diagnosis is likely to be important because tumour growth is very rapid and patients are at risk for a variety of serious complications including renal outflow tract obstruction, and neurological complications that can lead to total blindness (although this is a rare complicaton which occurs only in the context of cranial nerve palsies (predominently 2,4,6,7 and 12) and paraplegia.
The pediatric oncology program has also been working closely with the Pathology Program in order to improve diagnosis. Although throughout Africa, the diagnosis of Burkitt lymphoma has been by aspiration followed by cytological examination with simple Giemsa staining, the quality of the cytological preparations has not been of high quality and the Pathology Program is in the process of examining the use of monoclonal antibodies for diagnosis. This will increase the cost of diagnosis but will avoid costly mistakes caused by misdiagnosis, and may be the better route. An alternative would be the use of FISH, but this is likely to be somewhat more complex in Africa. Feasibility will be a major goal. The study of diagnosis will be conducted in conjunction with the Pediatric P:rogram