Browsing by Author "Wachtel, A"

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Catalyzing Childhood Cancer Care in Peru After One Year of the Global Initiative for Childhood Cancer
(American Society of Clinical Oncology, 2021) Vasquez, L; Maradiegue, E; Rojas Montoya, J; Zapata, A; Ugaz, C; Pascual, C; Santillán, C; Wachtel, A; Celis, E; Bernedo, H; Rossi, J; Saldaña, L; Diaz, R; Morales, R; Perez, V; Metzger, ML; Luciani, S
Tesis desarrollada en el ámbito de la Ingeniería, orientada al análisis y/o solución de problemáticas técnicas propias de la disciplina.
Clinical characteristics and outcomes of children with WAGR syndrome and Wilms tumor and/or nephroblastomatosis: The 30-year SIOP-RTSG experience
(John Wiley and Sons Inc., 2021) Hol, JA; Jongmans, MCJ; Sudour-Bonnange, H; Ramírez-Villar, GL; Chowdhury, T; Rechnitzer, C; Pal, N; Schleiermacher, G; Karow, A; Kuiper, RP; de Camargo, B; Avcin, S; Redzic, D; Wachtel, A; Segers, H; Vujanic, GM; van Tinteren, H; Bergeron, C; Pritchard-Jones, K; Graf, N; van den Heuvel-Eibrink, MM; International Society of Pediatric Oncology Renal Tumor Study Group (SIOP-RTSG)
Background: WAGR syndrome (Wilms tumor, aniridia, genitourinary anomalies, and range of developmental delays) is a rare contiguous gene deletion syndrome with a 45% to 60% risk of developing Wilms tumor (WT). Currently, surveillance and treatment recommendations are based on limited evidence. Methods: Clinical characteristics, treatments, and outcomes were analyzed for patients with WAGR and WT/nephroblastomatosis who were identified through International Society of Pediatric Oncology Renal Tumor Study Group (SIOP-RTSG) registries and the SIOP-RTSG network (1989-2019). Events were defined as relapse, metachronous tumors, or death. Results: Forty-three patients were identified. The median age at WT/nephroblastomatosis diagnosis was 22 months (range, 6-44 months). The overall stage was available for 40 patients, including 15 (37.5%) with bilateral disease and none with metastatic disease. Histology was available for 42 patients; 6 nephroblastomatosis without further WT and 36 WT, including 19 stromal WT (52.8%), 12 mixed WT (33.3%), 1 regressive WT (2.8%) and 2 other/indeterminable WT (5.6%). Blastemal type WT occurred in 2 patients (5.6%) after prolonged treatment for nephroblastomatosis; anaplasia was not reported. Nephrogenic rests were present in 78.9%. Among patients with WT, the 5-year event-free survival rate was 84.3% (95% confidence interval, 72.4%-98.1%), and the overall survival rate was 91.2% (95% confidence interval, 82.1%-100%). Events (n = 6) did not include relapse, but contralateral tumor development (n = 3) occurred up to 7 years after the initial diagnosis, and 3 deaths were related to hepatotoxicity (n = 2) and obstructive ileus (n = 1). Conclusions: Patients with WAGR have a high rate of bilateral disease and no metastatic or anaplastic tumors. Although they can be treated according to existing WT protocols, intensive monitoring of toxicity and surveillance of the remaining kidney(s) are advised.
Fortalecimiento de las políticas de salud pública contra el cáncer infantil: logros de Perú en el marco de la Iniciativa Mundial de la OMS contra el Cáncer Infantil
(Pan American Health Organization, 2023) Maradiegue, E; Pascual, C; Vasquez, L; Maza, I; Ugaz, C; Montoya, J; Zapata, A; García, H; Chavez, S; Ordoñez, K; Rossi, J; Diaz, R; Morales, R; Trigoso, V; Ames, R; Celis, E; Barzola, I; Torres, L; Cosme, M; Tarrillo, F; Rojas, N; Santillan, C; Quispe, Y; Palacios, V; Godoy, V; Tello, M; Tarco, D; Wachtel, A; Malaver, E; Diaz, E; Goyburu, M; Perez, V; Talavera, I; Baca, ME; Maza M; Saldaña, L; Holguin, A; Jarquin, M; Loggetto, P; Metzger, M; Friedrich, P; Lam, C; Rodriguez-Galindo, C
Objective. To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. Methods. A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Results. Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. Conclusions. The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.