Collaborating in Africa—small steps to sustainable success Trijn Israëls and Elizabeth M. Molyneux
The Collaborative Wilms Tumour Africa Project comprises eight centres in sub-Saharan Africa, which are implementing a treatment guideline that has been developed for local conditions. Uniform outcome evaluation, communication and training are all part of the project remit and will ultimately serve to improve cancer care for children in Africa. Israëls, T. & Molyneux, E. M. Nat. Rev. Clin. Oncol. 11, 691–692 (2014); published online 28 October 2014; doi:10.1038/nrclinonc.2014.189
Wilms tumour is the most common and curable kidney tumour in children. As with most solid tumours, the treatment is multi modal and includes chemotherapy and surgery, but also radiotherapy for a small group of patients with high-risk disease. As childhood tumours are rare, a long time is required for one centre to answer research questions and for treatments to eventually evolve. Accordingly, collaborative networks of centres have been formed and have been remarkably successful in driving progress. Integrat ing clinical trials into standard practice has also led to increased survival (>85%) in high-resource countries. The International Society of Paediatric Onco logy (SIOP) Renal Tumour Study Group (RTSG) in Europe and the Children’s Onco logy Group in North America have been instrumental to the progress made in highresource countries. By contrast, in regions without the same resourcing and without collaborative networks, survival is much lower. Although Francophone Africa has col laborated in clinical care and trials since 2000, a high degree of intercountry collaboration in the rest of the continent is lacking.1 Reported survival rates for patients with Wilms tumour in sub-Saharan Africa range from 11% in Sudan (with a high rate of incomplete treatment) to 45–50% in Malawi and in centres linked to the French African Paediatric Oncology Group.1–4 In Malawi, an adapted treatment guideline was imple mented in 2008, with modified SIOP pre operative chemotherapy, nutritional support and social support that enabled patients to complete treatment. This strategy improved