PAEDIATRIC AND ADOLESCENT CANCER
114 CANCER CONTROL 2014
References
1. Bey P. Le cancer en Afrique. Bull Cancer 2013; 100 : 112-3
2. Magrath I, Bey P, Shad A, Sutcliffe S. Cancer funding in developing countries: the next
health care crisis? Lancet 2010; 376: 1827
3. Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro R, Harif M, Li CK, Kebudi R,
Macfarlane SD, Howard S. Paediatric cancer in low-income and middle-income
countries. Lancet Oncol 2013; 14:e104-16
4. Rodriguez-Galindo C, Wilson MW, Chantada G et al. Retinoblastoma : one world, one
vision. Pediatrics 2008; 122: e763-70
5. Aerts I, Sastre-Garau X, Savignoni A, Lumbroso-Le Rouic L, Thebaud-Leculée E,
Frappaz D, Coze C, Thomas C, Gauthier-Villars M, Lévy-Gabriel C, Brisse HJ,
Desjardins L and Doz F. Results of a prospective study on the postoperative treatment
of unilateral retinoblastoma after primary enucleation. J Clin Oncol 2013; 31: 1458-63
6. Chantada GL, Qaddoumi I, Canturk S, Khetan V, Zhigui Ma, Kimani K, Yeniad B, Sultan
I, Sitorus RS, Tacyildiz N and Abramson DH. Strategies to Manage Retinoblastoma in
Developing Countries. Pediatr. Blood Cancer 2011; 56: 341-8
7. Epelman S. Preserving vision in retinoblastoma through early detection and
intervention. Curr Oncol Rep 2012;14: 213-9
8. Boubacar T, Fatou S, Fousseyni T, et al.A 30 month prospective study on the treatment
of retinoblastoma in the Gabriel Toure Teaching Hospital, Bamako, Mali. Brit J
Ophtalmol 2010; 94: 467-9
9. Traoré F, Togo B, Sylla F, Cheick TB, Diakité AA, Dicko-Traoré F, Sylla M, Sidibé T, Doz F,
Harif M, Bey P, Desjardins L. Le rétinoblastome: état des lieux au Mali et programme
d'aide au diagnostic précoce, aux traitements et à la réhabilitation. Bull Cancer 2013;
100 : 161-5
10.eden T. Curing paediatric cancer in the developing world. Cancer Control, Global Health
Dynamics 2013; pp 104-7
11.lumbroso-Le Rouic L, Aerts I, Levy-Gabriel C, Dendale R, Sastre X, Esteve M, Asselain
B, Bours D, Doz F, Desjardins L. Conservative treatments of intraocular
retinoblastoma. Ophtalmology 2008; 115: 1405-10
attended by the press. During this visit, after two days of
training, the first ocular prosthesis was carried out at IOTA
(Figure 1).
From October 2011 to October 2013, 68 new cases of
retinoblastoma in children were diagnosed and treated
(despite a war in the north of the country) by the Bamako
multidisciplinary team (15% came from neighbouring
countries). It is too early to have a clear assessment of the
evolution of the stages at diagnosis with time, but only 40%
had advanced disease at presentation (versus 60% in the
historical series 2005-2007). Of the 30 intraocular unilateral
cases, 85% are now in complete remission. All enucleated
children in this new series received an ocular prosthesis.
Conservative treatment for bilateral cases will be available in
early 2014.
It was decided to extend the programme in other countries
and Lubumbashi in the Democratic Republic of Congo was
chosen on the same criteria:
‰ The availability of core skills through a paediatric
oncology unit supported by GFAOP, located in the
University Clinics of Lubumbashi, close to the
ophthalmology department.
‰ That the doctors engaged in the care of retinoblastoma
(paediatric oncologist Dr R Lukamba, ophthalmologist
Professor G Chenge and pathologist Professor J Ilunga),
had the support of the authorities of the hospital, the
university and the province of Katanga.
The programme was officially launched on 5 December
2012, with a conference in the faculty of medicine at
Lubumbashi with an audience of 250 people. This took place
during a visit like the first one in Bamako. The training of an
ophthalmologist and of a technician for ocular prosthesis was
undertaken in Paris early in 2013.
For these two centres, regular follow-ups were organized
by conference call.
The programme continues to expand and visits, on the
same basis, were conducted in October 2013 in Dakar
(Senegal) and in Abidjan (Ivory Coast). Next year, we plan to
implement a programme in Madagascar and probably later in
one or two other countries.
So, finally, we plan to cover about 200 new cases of
retinoblastoma each year (out of at least 2,000 appearing
each year in the whole of Africa) and hope to reduce the
mortality which was about 70% to less than 30% and to
reduce blindness and other after-effects.
This may seem like a drop in the ocean, but we think that
retinoblastoma, even if it is not a health priority according to
its scarcity, is a special tumour, the only one curable in almost
100% of cases, whereas in the absence of treatment death
occurs after a spectacular and painful evolution. We are
convinced that the success of such a programme will go far
beyond this single tumour and will benefit the entire fight
against childhood cancer. l
Figure 2: The first ocular prosthesis being performed in Bamako, Mali