Acknowledgement to reviewers

No abstract available.

Corrigendum: Estimation of the effects of radiotherapy treatment delays on tumour responses: A review

No abstract available.

Erratum: Understanding bias in the medical literature: With reflections on metastasectomy

No abstract available.

Determinants of survival in children with cancer in Johannesburg, South Africa

Background: Childhood cancer, although rare, remains an important cause of death worldwide. The outcomes of children with all cancer types in South Africa are not well-documented.Aim: The aim of the article was to determine local childhood cancer survival rates and establish determinants of survival.Setting: The study was conducted at a state and a private hospital in South Africa.Methods: This retrospective cohort study consecutively included all children with a proven malignancy from 01 January 2012 to 31 December 2016. Univariable and multivariable analyses were used to establish which factors significantly impacted overall survival (OS).Results: Of a total of 677 study participants, 71% were black South Africans. The estimated 5-year overall survival (OS) was 57% (95% confidence interval [CI]: 53-61%) and significant determinants of OS on the multivariable analysis included: ethnicity, cancer-type and nutritional status. White and Indian patients had higher OS compared to black patients (hazard ration [HR] (95% CI) 0.46 (0.30-0.69) p = 0.0002 and HR (95%) 0.38 (0.19-0.78) p = 0.0087, respectively). Underweight patients had inferior survival (HR (95% CI) 1.78 (1.28-2.47)) p = 0.0006. Patients with neuroblastoma had an increased risk of dying compared to those with leukaemia (HR [95% CI] 1.78 [1.08-2.94]) p = 0.025. Progression of disease was the most common cause of death, followed by disease relapse.Conclusion: The childhood cancer survival rate obtained in this study can be used as a baseline to facilitate improvement. Non-modifiable prognostic factors included ethnicity and cancer-type whilst modifiable risk factors included undernutrition. Undernutrition should be addressed on a national and local level to improve survival.

Patients’ characteristics, Cytochrome P4501A1 genetic polymorphisms and breast cancer risk in Sudanese women

Background: The CYP1A1 catalyses polycyclic aromatic hydrocarbons activation to reactive metabolites, causing deoxyribonucleic acid (DNA) damage and cancer. It is highly polymorphic and displays ethnic differences in various populations.Aim: To evaluate the association of three polymorphic variants in the CYP1A1 gene with breast cancer in Sudanese women.Sett ing: This is a case-control study.Methods: After consenting, the participants completed questionnaires consisting of sociodemographic data, gynaecological status, and breast cancer history. We recorded clinical data, weight, and height for each woman and drew blood for PCR and RFLP analyses for CYP1A1 genotyping.Results: The CYP1A1 M1 and CYP1A1 M3 genotypes and homozygous CYP1A1 M1 (C/C) and CYP1A1 M3 (C/C) genotypes are not associated with breast cancer risk and menopausal status in women. The homozygous CYP1A1 M2 (A/A) genotype had a significant association with a risk reduction of breast cancer in premenopausal women. In contrast, the heterozygous CYP1A1 M2 (A/G) and the homozygous (G/G) are associated with significant breast cancer risk.Conclusion: Despite the limitations encountered in this study that included the small sample size and availability of age-matched controls, the results suggest that the CYP1A1 M2 polymorphism, educational level, and family history of breast cancer may have an association with the risk of developing breast cancer amongst Sudanese women and warrant confirmation in more extensive studies.

Delays in the referral and primary management of cutaneous malignant melanoma at Tygerberg Hospital

Background: Cutaneous malignant melanoma (CMM) is a significant cause of skin cancer-related mortality. The time between the diagnostic biopsy and primary surgical excision, the surgical interval (SI), is a modifiable factor that may impact melanoma outcomes. Delays in the SI are attributable to many factors.Aim: To determine the SI in patients with resectable CMM treated at Tygerberg Academic Hospital (TAH).Methods: A retrospective review of patients referred to the TAH multidisciplinary melanoma clinic with histologically confirmed CMM between January 2015 and December 2017 was done. Patients 18 years with resectable melanoma (T1b-T4b N0-3 M0-1a) who received definitive surgery were included.Results: The cohort (n = 40) comprised mostly Caucasians referred from the Cape metropolitan (metro) area, with a median age at diagnosis of 59 years. Thirty-one (77.5%) patients had T3 or T4 lesions on diagnostic biopsy. Twenty patients (50%) underwent a sentinel lymph node biopsy (SLNB) which led to an upstaging in 20% of cases. The median length of the SI was 13.5 weeks. Eighteen patients (45%) underwent primary excision within the recommended 12 weeks from diagnostic biopsy. There was a significant association between the SI and patients living in the Cape metro (p = 0.04) as well as the SI and p Stage (p = 0.01).Conclusion: Surgical interval guidelines for cutaneous melanoma are poorly defined. We used 12 weeks as an extrapolation of international guidelines. Even though this target was not met, the study is proposed to be of value in guiding future protocols and ultimately allowing for improved, timely service to patients.

A retrospective review of conventional versus hypo-fractionated pelvic radiotherapy for locally advanced cervical cancer, in limited-resource countries: The Uganda experience

Background: Cervical cancer incidence in Uganda is 54.8 per 100 000 population. We annually treat over 800 new cervical cancers (40% of the workload), which is challenging to treat such numbers in limited resources settings. From July 2011, we commenced the use of hypo-fractionated radiotherapy (HFRT) of 45 Gy/15 fraction (#) as an alternative to conventional fractionated radiotherapy (CFRT) of 50 Gy/25#, for treatment of locally advanced cervical cancer (LACC).Aim: To compare the 5-year follow-up treatment outcomes between CFRT and HFRT.Settings: The study analysed patients treated at the Uganda Cancer Institute – a limited resource institution.Methods: This was a non-randomised, retrospective study, where 414 patients’ files were reviewed according to demographic, clinical, radiotherapy fractionations and outcomes. Inclusion criteria were International Federation of Gynecology and Obstetrics stages IIB–IIIB cervical cancer cases and had completed external beam radiotherapy and intracavitary radiotherapy.Results: Squamous cell carcinomas were 93.6% and adenocarcinomas were 3.0%. The median age was 49.5 (interquartile range [IQR]: 40.0–56.0) years. Stages IIB/IIIA/IIIB were 36.2%, 8.2%, 55.6%, respectively. Human immunodeficiency virus serology was positive, negative, and unknown in 70 (16.9%), 116 (28.0%) and 228 (55.1%), respectively. Concurrent chemo-radiation was administered in 182 (44.0%) patients. Conventional fractionated radiotherapy and HFRT were 221 (53.4%) and 193 (46.6%), respectively. At 6 months, the overall response rate was 73.3% for CFRT compared with 67.6% for HFRT (p = 0.085), whilst the grades 0–1 toxicities were 94.5% and for 94.7% CFRT and HFRT, respectively (p = 0.080). At 60 months, the survival probabilities were 44.9% for CFRT and 46.6% for HFRT (p = 0.293).Conclusion: There is no significant statistical difference between CFRT and HFRT for the treatment of LACC. The HFRT could be considered for high volume limited resource settings.

The translocation t(1;19)(q23;p13) (TCF3/PBX1 fusion) is the most common recurrent genetic abnormality detected amongst patients with B-cell lymphoblastic leukaemia in Johannesburg, South Africa

Background: B-cell lymphoblastic leukaemia (B-ALL) is a malignancy of immature B-cells with several described recurrent genetic abnormalities. These have distinct clinico-pathological associations and show regional variation in prevalence. In all previously reported series, the translocation t(1;19) is uncommon, comprising 10% of all cases. The genetic composition of B-ALL in Africa is unknown.Aim: The aim of this study was to assess the genetic landscape of B-ALL in Johannesburg, South Africa.Setting: The Johannesburg state-sector.Methods: All cases of B-ALL diagnosed by flow cytometry in the state-sector hospitals of Johannesburg over 36 months between 2016 and 2019 were identified and pertinent data were recorded from the laboratory information system.Results: A total of 108 patients with B-ALL were identified, 82 (75.9%) of whom were children or adolescents. The translocation t(1;19)(q23;p13) was the most common genetic abnormality identified (23.7% of cases), predominating in young patients. The translocation t(9;22)(q34;q11) was the next most common aberration (17.5%) occurring predominantly in adults 40 years of age, but also in 8.1% of children. Crude survival rates were overall poor (44.6% overall and 57.4% in patients 18 years of age). On survival analysis, older age, KMT2A-rearrangement and t(1;19) were independently associated with relapse-related death. The t(9;22) was not associated with mortality independently from age.Conclusion: B-ALL shows a distinct pattern of lymphoblastic leukaemia-associated chromosomal translocations in Johannesburg.