Background: The AHOPCA (Asociación de Hemato-Oncología Pediátrica de Centro América) Wilms tumor (WT) treatment guidelines, adapted from NWTS-4 and -5 and recommending upfront nephrectomy (UN), were modified to include 4 to 6 weeks of preoperative chemotherapy (POC) in frail patients with advanced disease. We aim to describe the outcomes of this implemented approach. Procedure: A retrospective analysis of prospectively collected data from newly diagnosed patients with unilateral WT between 2012 and 2018. Results: Of 353 eligible patients, 247 (70%) received POC. POC group had higher initial tumor volume (median 590 ml vs. 308 ml, p<0.0001) and more stage IV disease (30% vs. 3%, p<0.0001) compared to UN group. During POC, there were 4 deaths, 14 abandonments and 11 progressive diseases. After response assessment, 62% showed partial tumor response with median tumor volume reduction to 257 ml. Two-hundred eighteen (88.2%) underwent nephrectomy. Tumor rupture/spillage occurred in 17.9% of UN and 18.8% of POC group; Local stage III was found in 55% of UN and 68.3% of POC group. Anaplasia (focal and diffuse) was present in 13.6% (17% UN and 11.9% POC). The 5-year abandonment-sensitive event-free survival (asEFS) and abandonment-sensitive overall survival (asOS) rates were 69%±2.5% and 75%±2.4%, respectively. The asEFS rates were 75%±4.3% for UN and 66%±3.0% for POC (p=0.07). Conclusions: Many AHOPCA patients presented with unresectable advanced disease, necessitating the use of POC. POC effectively reduced tumor volume and facilitated safe surgery in fragile patients. Adopting the standard SIOP WT neoadjuvant approach could enhance staging and risk stratification in AHOPCA.

Since 2000, centers across Central America have shared treatment guidelines for Wilms tumor, using histology (anaplasia present or absent) and tumor stage to stratify patients into low, intermediate, and high-risk groups. Weekly virtual tumor board meetings involving local and international experts were held to ensure consistent treatment assignments. We analyzed data from 367 children with unilateral tumor treated per these guidelines. Five-year abandonment-sensitive event-free and overall survival estimates were: low-risk 82% ±3.8% and 86% ±3.6%, intermediate-risk 50% ±3.4% and 60% ±3.4%, and high-risk 36% ±7.6% and 45% ±7.9%. Survival outcomes were suboptimal, primarily due to advanced disease in fragile children at presentation and abandonment of treatment.

Background/Objectives: High-risk Hodgkin lymphoma (HRHL) in children is a curable with combined modality therapy. The AHOPCA is a consortium of cancer centers from Central America. In 2004, AHOPCA implemented a guideline with a short course of chemotherapy (mStanfordV), strict diagnostics and radiation guidelines, aimed at reducing abandonment and improving outcomes. Methods: Newly diagnosed children less than 18 years of age with high-risk HL (Ann Arbor stages: IIB, IIIB, IV) from AHOPCA centers were staged with chest X-ray, and ultrasound or CT. Therapy was a modified StanfordV (mStanfordV) substituting cyclophosphamide for mechlorethamine and involved field radiation. Results: Of 219 patients with HRHL, 181 patients were eligible and evaluable;146 (81%) were boys, 22% being less than 6 years; 43 were stage IIB, 84 IIIB and 54 IV. Thirty-one (17%) abandoned therapy, 28 (15%) progressed, 30 (17%) relapsed and 8 (4%) died of toxicity. Radiation guidelines were not followed. Five-year abandonment-sensitive event-free survival and overall survival (AS-EFS, AS-OS±SE) for the cohort were 46±4% and 56±4%; 5-year AS-OS for stages IIB, IIIB and IV was 76±7%, 59±7%, and 35±7% (p=0.0006). Conclusion: Despite instituting a short treatment guideline, it did not improve the abandonment rate (17%) and did not achieve the reported outcomes of StanfordV. The cyclophosphamide dose used to replace merchlorethamine was inadequate. Despite strict guidelines, the radiation therapy application was inaccuarate. Weekly chemotherapy may have adversely affected abandonment of therapy by increasing the burden of travel-time. Based on these results, AHOPCA established a new abandonment strategy and a new guideline.

The ongoing COVID-19 pandemic strained medical systems worldwide. We report on the impact on pediatric oncology care in Latin American (LATAM) during its first year. Four cross-sectional surveys were electronically distributed among pediatric onco-hematologist in April/June/October 2020, and April/2021 through the Latin American Society of Pediatric Oncology (SLAOP) email list and St Jude Global regional partners. 453 pediatric onco-hematologists from 20 countries responded the first survey with subsequent surveys response rates above 85%. More than 95% of participants reported that treatment continued without interruption for new and active on-going patients, though with disruptions in treatment availability. During the first three surveys, respondents reported suspensions of outpatient procedures (54.2%), a decrease in oncologic surgeries (43.6%), radiotherapy (28.4%), stem cell transplants (SCT) (69.3%), and surveillance consultations (81.2%). Logistic regression analysis showed that at the beginning of the first wave, participants from countries with healthcare expenditure below 7% were more likely to report a decrease in outpatient procedures (OR:1.84, 95%C:1.19;2.8), surgeries (OR:3, 95%CI:1.9;4.6) and radiotherapy (OR:6, 95%CI:3.5;10.4). Suspension of surveillance consultations was higher in countries with COVID-19 case fatality rates above 2% (OR:3, 95%CI:1.4;6.2) and SCT suspensions in countries with COVID-19 incidence rate above 100 cases per 100,000 (OR:3.48, 95%CI:1.6;7.45). Paradoxically, at the beginning of the second wave with COVID-19 cases rising exponentially, most participants reported improvements in cancer services availability. Our data show the medium-term collateral effects of the pandemic on pediatric oncology care in LATAM, which might help delineate oncology care delivery amid current and future challenges posed by the pandemic.