[Therapeutic adaptations: Rationale, achievements and limits. Experience of GFAOP]

In high-income countries such as in Europe, cure rate of children with cancer is high thanks to prospective therapeutic studies, generally randomized. In countries with lower income, these validated and published treatments can be difficult to apply necessitating adaptations to reduce toxicity while trying to maintain cure rate as high as possible. These adaptations to take into consideration local conditions depend on the experience of the treating unit, on the means available such as drugs, supportive care, complementary examinations, especially radiologic. Since the year 2000, GFAOP has selected for the sub-Saharan countries, 2 (Burkitt lymphoma, nephroblastoma), then 3 other pathologies (Hodgkin lymphoma, lymphoblastic leukemia, retinoblastoma) which has cure rates of 90% in France with cheap drugs. The objective of this article is to show how the adapted therapeutic recommendations (accompanied by team training and drug supply) prospectively evaluated, allowed us to know and to increase cure rates and to identify points to improve in the following studies. Among difficulties to overcome in Africa: the absence of health coverage and the late arrival of the children in the specialized units. Presently cure rate of the children who can be treated according to these recommendations are around 50-60%, trying to reach the 60% cure rate fixed by WHO for 2030.