Malignant solid tumours in neonates: an African perspective

Area of Science:

• Pediatric Oncology
• Neonatal Pathology
• Cancer Therapeutics

Background:

• Neonatal malignant tumors exhibit distinct pathological, clinical, and therapeutic characteristics compared to older children and adults.
• Histological appearance alone is insufficient for predicting behavior, complicating risk stratification in neonates.
• A 20-year review of 42 patients with neonatal malignancies was conducted.

Purpose of the Study:

• To analyze the characteristics, management, and outcomes of various malignant tumors in neonates.
• To evaluate the effectiveness and toxicity of chemotherapy in this age group.
• To assess risk stratification methods for neonatal neuroblastoma in the absence of specific markers.

Main Methods:

• Retrospective review of 42 neonatal cancer patients over a 20-year period.
• Initial management focused on surgical intervention where feasible.
• Chemotherapy administration with dose reduction and monitoring for morbidity/mortality.

Main Results:

• Soft-tissue sarcomas (14) were the dominant group, followed by neuroblastoma (11).
• Congenital fibrosarcoma showed good outcomes (86% survival), while rhabdomyosarcoma had no survivors.
• INSS staging for neuroblastoma indicated good prognosis for Stage I, uniformly fatal for Stage IV, and 50% early survival for Stage IVs.
• Renal tumors (nephroblastoma, mesoblastic nephroma) had favorable outcomes.
• Immature teratomas had a 29% survival rate among known survivors, with significant loss to follow-up (43%).

Conclusions:

• Neonatal cancers require distinct management strategies.
• Chemotherapy in neonates carries significant risks.
• Risk stratification for neonatal neuroblastoma relies on INSS staging.
• Outcomes vary significantly by tumor type, with renal tumors faring well and some sarcomas having poor prognoses.