Childhood cancer in Rio Grande do Norte: a 30 year report
Cancer, Co-morbidities, visceral leishmaniasis, lymphoma, immunity
Neoplastic disorders are an increase health problem worldwide for both children and adults. The purpose of this study was to determine the prevalence, the morbidity and the mortality of neoplastic disorders in children living in the state of Rio Grande do Norte, Brazil. In addition, co-morbidities as symptomatic visceral leishmaniasis was determined. With this goal, a longitudinal retrospective study of children diagnosed with cancer at the Pediatric Oncology Center of the Hospital Infantil Varela Santiago and at the Outpatient Clinic at Department of Pediatrics of the Federal University of Rio Grande do Norte (UFRN) was performed. Cases were diagnosed between 1977 and 2007. The variables analyzed included sex; age; place of residence; type of cancer, level of disease, and treatment protocol used and outcomes. Survival rates and co-morbidities were determined by Kaplan-Meier analysis. This study had a total population of 1,432 children of which 60% were males and 40% were females. The age group with the highest prevalence was 1-9 years, 60% of the total population; 95.3% of the children were from Rio Grande do Norte of which 50.5% lived in Natal. The most frequent type of cancer was Acute Leukemia (38.7%) followed by Lymphomas (24.3%), neuroblastomas (7.5%), Wilms’ Tumors (6.6%), central nervous system (6.1%) Hodgkin’s Lymphomas (5.9%), retinoblastomas (4.3%), histiocytosis (3.7%), osteosarcomas (2.9%), rhabdomyosarcomas (2.0%), Botryoid sarcoma and immature teratomas (1.3%), hepatoblastomas (0.5%) and others (2.3%). The mean survival rate accumulated in 60 months was of 56.9%, however, in some types of cancers such as, Wilm’s Tumors (76.9%), lymphomas (72.6%), retinoblastomas (68.1%) and the immature teratomas (68.4%) significant reductions was achieved in relation to global survival rates. Sixty percent (60%) of the mortality occurred during the first year of their evaluation and was due primarily to the advanced stages of the disease. The age group of 1-9 years was the most prevalent (60% of the cases). Substantial improvement in survival occurred after 2007, primarily due to early diagnosis, the advance in treatment protocols and the exchange of information with local and international institutions that treat children with cancer.