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Childhood cancer is a priority in Egypt due to large numbers of children with cancer, sub-optimal care and insufficient resources. It is difficult to evaluate progress in survival due to paucity of data in national cancer registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n=15,779, aged 0-18 years) from Egypt between 2007-2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40-50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14,808 eligible patients using Kaplan Meier method, and determined survival trends using Cox regression by single year of diagnosis, and diagnosis periods. We compared age-standardized rates to international benchmarks in England and the US, identified cancers with inferior survival, and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (p

Background Nasopharyngeal carcinoma is rare in children and adolescents; however, it has a better prognosis than in adults. Nevertheless, its prognostic factors are not clearly documented. Patients and methods A prospective single-arm study was performed in 32 nonmetastatic Stages II–IV nasopharyngeal carcinoma (NPC) patients, below age 18 years. The treatment regimen included three courses of neoadjuvant chemotherapy (cisplatin and fluorouracil) followed by concomitant chemoradiotherapy (simultaneous integrated boost-intensity modulated radiotherapy [SIB-IMRT] with three cycles of cisplatin). Results All patients completed their prescribed treatment with tolerable acute side-effects. The 3-year overall (OS), event-free (EFS), local recurrence-free (LRFS), and distant metastasis-free (DMFS) survival rates were 83 ± 8, 77 ± 8, 92 ± 6 and 77 ± 9 percent, respectively. Although the median initial (pretreatment) gross tumor volume of the primary site (GTVp) increased with increasing stage, yet these differences did not rank to the level of significance. However, GTVp (with a cut-off value of 54.5 mL) was the only significant prognostic factor determining OS, EFS, LRFS and DMFS. On the other hand, age, gender, T stage, AJCC stage and footprint histopathological EBV did not have statistical significant impact on any survival rate. The late toxicity of this regimen was much lower than that reported with the conformal treatment. Conclusion Neoadjuvant chemotherapy and concomitant chemo-radiotherapy using SIB-IMRT led to excellent outcome with reduced late toxicity in juvenile nasopharyngeal carcinoma. GTVp is the sole prognostic factor that showed statistical impact on survival rates when applying this regimen.

Perforation is the most common surgical complication in pediatric intestinal lymphoma. During operation, many surgical decisions are debatable.To assess the outcome of surgical management of perforated pediatric intestinal lymphoma.This is a retrospective analysis of all pediatric patients (18 years old) with intestinal lymphoma treated in our hospital between July 2007 and June 2017. Risk factors for perforation, type of management and outcome in cases of intestinal perforation were analyzed.The study included 240 patients with intestinal lymphoma. Perforation developed in 16 patients (6.7%) with a median age of 5.3 (range: 2.8-15.7) years. Most of the patients (92.5%) had Burkitt lymphoma. The ileum was the most common site of perforation (n = 10). Perforation occurred at presentation (n = 2), during induction (n = 10), during maintenance chemotherapy (n = 2), or at relapse (n = 2). Primary resection anastomosis was done in 12 patients. The resected specimen showed a viable tumor in ten patients. Wound infection (25%) and dehiscence (12.5%) were the most common postoperative complications. The 5-year overall and event-free survivals of patients with perforation were 78.6% and 71.4%, respectively, compared with 85.5% and 81.2% in non-perforated patients; the difference was not significant (p = 0.374 and p = 0.270, respectively).Perforation is not an adverse prognostic factor for survival in pediatric intestinal lymphoma patients. Primary resection anastomosis seems to be a safe option if complete tumor resection is feasible.

A male child presented with left lacrimal gland and right submandibular masses that were diagnosed as high grade B-cell non-Hodgkin's Lymphoma. Immunodeficiency was suspected, mostly due to secondary to Epstein Barr virus infection. Chemotherapy was started and gradual regression was observed in the size of the lesions forming a central necrosis and facial wound. Cultures from this wound showed mixed gram negative growth of Pseudomonas aeruginosa, and Escherichia coli. Two days later, a follow up swab of the wound was taken and showed fungal growth of mixed Candida tropicalis and Cryptococcus laurentii which was treated with two antifungals (fluconazole and liposomal amphotericin B). After a second chemotherapy cycle, the facial necrotic lesion increased in size and the patient's general condition markedly deteriorated with multi-organ system failure secondary to septic shock by candidemia. Candida glabrata, which is non-Candida albicans fungus was the fungus that appeared in the patient's blood culture. Caspofungin was prescribed in addition to liposomal amphotericin B. two days later, the follow up blood culture revealed growth of methicillin resistant Staphylococcus aureus and the pulmonary condition of the patient then deteriorated gradually. Six days later, the patient developed multi-organ dysfunction syndrome secondary to sepsis. We conclude that we mixed fungal infection in not uncommon among immunocompromised patients, candidemia is fatal even if treated with the correct antifungals.

Primary hyperoxalurias are rare inborn errors of metabolism with deficiency of hepatic enzymes that lead to excessive urinary oxalate excretion and overproduction of oxalate which is deposited in various organs. Hyperoxaluria results in serious morbid-ity, end stage kidney disease (ESKD), and mortality if left untreated. Combined liver kidney transplantation (CLKT) is recognized as a management of ESKD for children with hyperoxaluria type 1 (PH1). This study aimed to report outcome of CLKT in a pediatric cohort of PH1 patients, through retrospective analysis of data of 8 children (2 girls and 6 boys) who presented by PH1 to Wadi El Nil Pediatric Living Related Liver Transplant Unit during 2001-2017. Mean age at transplant was 8.2 ± 4 years. Only three of the children underwent confirmatory genotyping. Three patients died prior to surgery on waiting list. The first attempt at CLKT was consecutive, and despite initial successful liver transplant, the girl died of biliary peritonitis prior to scheduled renal transplant. Of the four who underwent simultaneous CLKT, only two survived and are well, one with insignificant complications, and other suffered from abdominal Burkitt lymphoma managed by excision and resection anastomosis, four cycles of rituximab, cyclophosphamide, vincristine, and prednisone. The other two died, one due to uncontrollable bleeding within 36 hours of procedure, while the other died awaiting renal transplant after loss of renal graft to recurrent renal oxalosis 6 months post-transplant. PH1 with ESKD is a rare disease; simultaneous CLKT offers good quality of life for afflicted children. Graft shortage and renal graft loss to oxalosis challenge the outcome.