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South African Journal of Oncology
2024-03-13T23:29:13+01:00
AOSIS Publishing
submissions@sajo.org.za
Open Journal Systems
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https://sajo.org.za/index.php/sajo/article/view/269
DNA methylation microarray analysis of adult gliomas: A pilot study at Groote Schuur Hospital
2024-03-13T23:29:13+01:00
Brendon Price
brendon.price@nhls.ac.za
<p><strong>Background:</strong> Accurate glioma diagnosis requires a combination of histology, radiology and identification of key genetic mutations. Currently, multiple tests are required to identify these mutations. Deoxyribonucleic acid (DNA) methylation microarray coupled with digital classification algorithms can subclassify gliomas and identify multiple mutations in a single experiment, thereby potentially replacing current modalities and reduce turnaround times.</p><p><strong>Aim:</strong> This study aims to compare results obtained by DNA methylation microarray on select adult glioma cases previously classified and graded on the basis of morphology and currently available ancillary tests.</p><p><strong>Setting:</strong> Cape Town, South Africa.</p><p><strong>Methods:</strong> Eight cases comprising astrocytic and oligodendroglial tumours (WHO grades 2–4) were analysed using the Illumina Infinium MethylationEPIC 850k microarray platform. Tumour classification and O<sup>6</sup>-methylguanine DNA-methyltransferase (MGMT) promoter methylation status were determined via online classification algorithms. Key genetic and chromosomal changes were identified by copy number variation plots.</p><p><strong>Results:</strong> Seven of the eight cases were successfully assigned a methylation class and showed concordance with previously determined histological tumour type, isocitrate dehydrogenase and 1p/19q co-deletion status. Of these, tumour grading remained unchanged in five cases, upgraded in one case and downgraded in the other. The remaining case could not be classified. The MGMT promoter methylation status and diagnostically relevant copy number variants were also identified.</p><p><strong>Conclusion:</strong> Tumour classification and grading can be accurately determined by methylation microarray analysis in adult gliomas.</p><p><strong>Contribution:</strong> Methylation microarray provides greater molecular information than current methods, thereby potentially improving diagnostic accuracy and patient prognostication.</p>
2024-03-13T07:00:00+01:00
Copyright (c) 2024 Brendon Price
https://sajo.org.za/index.php/sajo/article/view/279
Treatment outcomes of Epstein-Barr virus-associated nasopharyngeal carcinoma
2024-02-01T13:17:23+01:00
Santhuri Viranna
santhuri.viranna@uct.ac.za
Hue-Tsi Wu
Huetsi.wu@pathcare.net
Sameera Dalvie
s.dalvie@uct.ac.za
<p><strong>Background:</strong> Data on treatment outcomes of Epstein-Barr virus (EBV) associated nasopharyngeal carcinoma (NPC) largely comes from endemic regions. There is limited literature regarding the epidemiology and treatment outcomes of EBV-associated NPC in South Africa.</p><p><strong>Aim:</strong> The aim of the study was to compare overall survival (OS) of EBV positive and EBV negative NPC patients.</p><p><strong>Setting:</strong> Groote Schuur Hospital, South Africa.</p><p><strong>Methods:</strong> Data were collected on all patients with histologically confirmed NPC over an 11-year period, including prevalence of EBV, OS, disease-free survival (DFS), loco-regional control (LRC), and impact of treatment interruptions on OS.</p><p><strong>Results:</strong> There were 53 patients in total. Non-keratinising carcinoma was the primary histological subtype (86.8%). The majority of patients had EBV positive NPC (47.2%). The 2- and 5-year OS of EBV positive patients treated with curative intent were significantly higher than EBV negative patients, 84.0% versus 34.0% and 45.0% versus 17.0%, respectively (hazard ratio [HR] 0.25, 95% confidence interval [CI]: 0.10–0.63, <em>p</em> = 0.002). Two-year DFS was 55.0% versus 43.0% (HR: 0.59, 95% CI: 0.18–1.98, <em>p</em> = 0.38) and 2-year LRC were 76.2% versus 46.2% (HR: 0.40, 95% CI: 0.12–1.36, <em>p</em> = 0.13) for EBV positive and EBV negative patients respectively.</p><p><strong>Conclusion:</strong> Treatment of EBV-associated NPC is associated with superior OS compared to EBV negative tumours.</p><p><strong>Contribution:</strong> Epstein-Barr virus was found to be a significant prognostic factor associated with superior OS compared to EBV negative NPC. These findings correlate with literature from endemic and non-endemic regions.</p><strong></strong>
2024-01-29T06:00:00+01:00
Copyright (c) 2024 Santhuri Viranna, Hue-Tsi Wu, Sameera Dalvie
https://sajo.org.za/index.php/sajo/article/view/276
Epidemiology of head and neck cancer in a Johannesburg Hospital: A file review
2024-01-10T13:14:15+01:00
Kim Coutts
kim.coutts@wits.ac.za
Nicole Israel
nicky.israel@wits.ac.za
Zareen Cassim
zareen56@gmail.com
Engela Prinsloo
engelaprinsloo1234@gmail.com
<p><strong>Background:</strong> There is little to no epidemiological data on the presentation of head and neck cancer (HNC) patients in South Africa. These data are important to ensure that local teaching, research and health services meet the needs of this population.</p><p><strong>Aim:</strong> To describe the epidemiological data of HNC patients using a record review from a tertiary level hospital in Johannesburg, South Africa.</p><p><strong>Setting:</strong> This study was piloted in a tertiary public hospital in Gauteng, South Africa.</p><p><strong>Methods:</strong> Sixty files between 2015 and 2021 were analysed quantitatively to describe the trends of HNC patients presenting to the hospital. This was a pilot study to review if this methodology can be used for future larger scale studies in South Africa.</p><p><strong>Results:</strong> Missing data were a significant finding as well as a limitation of the study. The most common form of HNC was laryngeal cancer, and African males were the predominant demographic. The most common comorbidities were smoking, hypertension and HIV/AIDS. The majority of patients presented with speech and swallowing difficulties and various complications that required multidisciplinary team management.</p><p><strong>Conclusion:</strong> All HNC patients need to undergo early screening to assess for speech and swallowing difficulties to prevent further complications.</p><p><strong>Contribution:</strong> The data derived from this study are novel and specific to the South African population. More studies of this nature are required to increase the availability of epidemiological data for this population, in order to inform evidence-based practices.</p>
2023-12-18T07:00:00+01:00
Copyright (c) 2023 Kim Coutts, Nicole Israel, Zareen Cassim, Engela Prinsloo
https://sajo.org.za/index.php/sajo/article/view/282
Acknowledgement to reviewers
2023-12-04T08:05:13+01:00
Editorial Office
publishing@aosis.co.za
No abstract available.
2023-11-16T06:30:00+01:00
Copyright (c) 2023 Editorial Office
https://sajo.org.za/index.php/sajo/article/view/268
Testicular germ cell tumours: Outcomes at a tertiary hospital in the Western Cape, South Africa
2023-12-04T08:05:13+01:00
Gérard Grobler
gerard.grobler@gmail.com
Petrus V. Spies
spies@sun.ac.za
Henriette Burger
henrietteburger@sun.ac.za
Heidi van Deventer
heidivd@sun.ac.za
André van der Merwe
arvdm@sun.ac.za
<p><strong>Background:</strong> Testis cancer is a rare malignancy, and there are limited data describing Africa’s clinical characteristics and outcomes.</p><p><strong>Aim:</strong> We summarised 16 years of South African data, comparing it to available data for Africa and international data.</p><p><strong>Setting:</strong> The retrospective review included males > 12 years with testicular germ cell tumours diagnosed and treated at Tygerberg Hospital from 01 January 2005 to 31 December 2020.</p><p><strong>Methods:</strong> Self-declared racial status included Caucasian, mixed ethnicity, African and Asian. Patients were identified from uro-oncology and pathology records indicating any form of testicular cancer. Data were extracted for demographics, staging, treatment and outcomes. In addition, patients were contacted or tracked as part of a living status report by the Department of Home Affairs to determine the last contact date for survival outcomes.</p><p><strong>Results:</strong> There were 142 patients in the study. The most common risk factor was cryptorchidism (14.1%), but most patients reported no known risk factors (82.4%). Seminomas presented 10 years later than non-seminomatous germ cell tumours (NSGCTs). Having no risk factors seems to be protective hazard ratio (HR) 0.18 and being diagnosed after 40 years carries an increased risk of death. The histopathological classification was fairly equal, with 70 seminoma and 72 NSGCTs. There was no statistical difference in the stage distribution between seminoma and NSGCTs. The overall 5-year survival was 91% for seminoma compared with 78% in NSGCTs. With a time horizon of 15 years, a patient was expected to survive 16% (1.9 years) longer in the seminoma group. Clinical stage (CS) three patients had a higher risk of dying compared with CS1 and CS2, and there was no difference between seminoma and NSGCTs (HR = 12.6).</p><p><strong>Conclusion:</strong> The clinical characteristics of our patient population correspond to international data. There is a need for better health education to ensure patients present earlier and have access to appropriate medical care.</p><p><strong>Contribution:</strong> Our data represent the largest series of testis cancer outcomes at a single centre in Africa and the aim is to motivate other centres to describe and analyse their oncological outcomes to ensure we provide the best possible care to all our patients in South Africa’s future.</p>
2023-11-01T06:00:00+01:00
Copyright (c) 2023 Gérard Grobler, Petrus V. Spies, Henriette Burger, Heidi van Deventer, André van der Merwe
https://sajo.org.za/index.php/sajo/article/view/280
Experiences of families of men with prostate cancer on supportive care received from nurses
2023-11-02T10:57:47+01:00
Salomo Salomo
ssalomo@unam.na
Hans J. Amukugo
hamukugo@unam.na
Anna P.K. Shilunga
ashilunga@unam.na
<p><strong>Background:</strong> Family members of men diagnosed with prostate cancer (PCa) experience a range of supportive care needs. Literature indicated inconsistent supportive care from nurses to families of men diagnosed with PCa.</p><p><strong>Aim:</strong> Exploring and describing the experiences of family members of men diagnosed with PCa on the supportive care received from nurses.</p><p><strong>Setting:</strong> The study was conducted in the oncology departments of the Intermediate Hospital Oshakati.</p><p><strong>Methods:</strong> Qualitative, exploratory, descriptive, phenomenological and contextual designs were adopted. A sample of seven family members of men diagnosed with PCa was selected using a non-probability purposive sampling technique. Individual face-to-face interviews were conducted. Interview guide and field notes were used to collect data. All interviews were recorded with an audio recorder and transcribed verbatim. Content analysis using Tesch’s eight steps of open coding was adopted to analyse data. Criteria for establishing trustworthiness of the data were used. Fundamental ethical principles were adhered to.</p><p><strong>Results:</strong> The study revealed lack of family involvement in treatment and decision-making. Two themes emerged: (1) feeling of being devalued in the healthcare system, and (2) non-conducive environment for counselling men.</p><p><strong>Conclusion:</strong> It became evident that family members of men diagnosed with PCa are rarely considered in clinical practice. Recommendations are made in terms of policy formulation, organisational changes in the hospital protocols and staff training.</p><p><strong>Contribution:</strong> The study proposed the introduction of national policy on supportive care of men with PCa and an inclusion of their families during treatment and decision-making.</p><strong></strong>
2023-10-31T06:00:00+01:00
Copyright (c) 2023 Salomo Salomo, Hans J. Amukugo, Anna P.K. Shilunga
https://sajo.org.za/index.php/sajo/article/view/270
A retrospective analysis of concurrent chemoradiation for squamous cell carcinoma of the anus in Johannesburg
2023-12-04T08:05:13+01:00
Phemelo Tshoeu
dr.ptshoeu@gmail.com
Vinay Sharma
vinay.sharma@wits.ac.za
Paul Ruff
pruff@iafrica.com
<p><strong>Background:</strong> Anal cancer is a major cause of mortality and morbidity in low- and middle-income countries (LMICs).</p><p><strong>Aim:</strong> A retrospective analysis to understand presentation and outcomes of patients with anal cancer, who were treated with a curative intent.</p><p><strong>Setting:</strong> A radiation oncology unit in quaternary level hospital in South Africa.</p><p><strong>Methods:</strong> Medical records of patients with invasive squamous cell carcinoma (SCC) of the anal canal who were treated between 2014 and 2019 were reviewed with follow-up until June 2021. The 2D-radiotherapy planning and delivery techniques were used to a dose of 50 Gy, with a boost dose of 6 Gy – 10 Gy for patients with residual disease and concurrent chemotherapy.</p><p><strong>Results:</strong> Eighty-four patients were included in the analysis. Median age was 45 years (range: 25–73 years), 75% were female patients, 80% of the cohort was human immunodeficiency virus (HIV)-positive, and 17% with a CD4 count below 200 cells/mm<sup>3</sup>. Eighty-seven percent had locally advanced stage three disease. Concurrent 5-fluorouracil (5-FU) and mitomycin C-based chemotherapy was given in four patients, while 50% had 5-FU plus cisplatin and 16% had radiotherapy alone. Complete clinical response was observed in 54 out of 66 evaluable patients (81.8%) at 6 months post-chemoradiation. Overall survival at 2 years could not be determined because of a significant loss to follow-up rate.</p><p><strong>Conclusion:</strong> A high HIV-postive rate and an advanced disease stage were observed among cohorts with anal canal SCC treated with a definitive curative intent. Tumour response rates at 6 months were favourable although the 2-year overall survival could not be established.</p><p><strong>Contribution:</strong> This study contributes to the growing body of research on anal cancer outcomes in LMICs.</p>
2023-09-19T14:12:00+02:00
Copyright (c) 2023 Phemelo Tshoeu, Vinay Sharma, Paul Ruff
https://sajo.org.za/index.php/sajo/article/view/265
Gastrointestinal stromal tumours in patients presenting to an academic hospital in South Africa
2023-07-03T15:54:37+02:00
Barbara M. Robertson
barbara.robertson@uct.ac.za
Galya E. Chinnery
galyachinnery@gmail.com
Michael L. Locketz
michael.locketz@gmail.com
Michelle Parker
michelle.parker@uct.ac.za
Alvera A. Vorster
anna.vorster@uct.ac.za
Raj Ramesar
raj.ramesar@uct.ac.za
Eugenio Panieri
eugenio.panieri@uct.ac.za
Alistair J. Hunter
alistair.hunter@uct.ac.za
<p><strong>Background:</strong> Published information on African patients with gastrointestinal stromal tumours (GISTs) is limited.</p><p><strong>Aim:</strong> The aim of this study was to review patient and tumour characteristics, and treatment, for a cohort of African patients and compare findings to studies from other centres.</p><p><strong>Setting:</strong> Groote Schuur Hospital, South Africa.</p><p><strong>Methods:</strong> Data were collected on all patients referred to Groote Schuur Hospital (GSH) during the period October 2003 to November 2019, including demographics, tumour characteristics and treatment outcomes.</p><p><strong>Results:</strong> There were 124 patients in total. There was a slight male predominance (55.6%) and the median age was 56 years. The most common primary tumour sites were the stomach (66.2%) and small bowel (21.8%) with a median primary tumour diameter of 95.5 mm. Mutational analysis was conducted for 39 patients with 66.7% of these patients having mutations in <em>KIT</em> exon 11. The primary tumour was resected in 72 patients, with 48.6% having high-risk tumours according to the National Institutes of Health (NIH) risk assessment. The 10-year overall survival (OS) values for patients by risk group were 83% (very low and low risk), 73% (intermediate risk) and 66% (high risk). The disease control rate for patients treated with imatinib was 84.6%. The median progression-free survival (PFS) for patients treated with imatinib for palliation was 23 months with OS of 31 months.</p><p><strong>Conclusion:</strong> In contrast to patients from other centres, our patients were younger and had larger tumours.</p><p><strong>Contribution:</strong> The distribution of primary tumour site, mutational analysis and response to imatinib was consistent with the literature.</p>
2023-06-13T13:04:00+02:00
Copyright (c) 2023 Barbara M. Robertson, Galya E. Chinnery, Michael L. Locketz, Michelle Parker, Alvera A. Vorster, Raj Ramesar, Eugenio Panieri, Alistair J. Hunter
https://sajo.org.za/index.php/sajo/article/view/262
Comparison of 3D-conformal and intensity-modulated radiation therapy for left-sided breast cancer
2023-07-03T15:54:37+02:00
Hesta Friedrich-Nel
hfried@cut.ac.za
Deirdré Long
longd@ufs.ac.za
Nape M. Phahlamohlaka
nphahlamohlaka@cut.ac.za
<p><strong>Background:</strong> We compared 3D-conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) planning for left-sided post-mastectomy patients.</p><p><strong>Aim:</strong> To compare the dose coverage of the planning target volume (PTV) and dose delivered to organs at risk (OAR) of 3D-CRT and IMRT plans.</p><p><strong>Setting:</strong> Department of Oncology, central South Africa.</p><p><strong>Methods:</strong> Twenty-six archived CT scans of patients with left-sided breast cancer were included. The 3D-CRT and IMRT plans were designed for each patient and compared using the Monaco<sup>©</sup> planning system (version 5.11.02). Statistical analysis was performed for PTV coverage (V<sub>95%</sub>, V<sub>98%</sub>, V<sub>105%</sub>) and radiation doses to the heart, ipsilateral lung, combined lungs, contralateral breast, and oesophagus.</p><p><strong>Results:</strong> The V<sub>98%</sub> and V<sub>105%</sub> target volume dose coverage for the 3D-CRT plans were 67.07% and 0.21%, respectively, compared to 92.32% and 1.10% of the IMRT plans. However, the IMRT plans’ mean volume of PTV, receiving 95% of the prescribed dose (PD), was 7.68% compared to the 3D-CRT’s 32.93%. The IMRT plans resulted in a V<sub>22</sub> Gy < 10% for the heart, with a value of 4.15%. The V<sub>18.87</sub> Gy < 45% values for the ipsilateral and combined lungs were 28.09% and 13.70%, respectively. The 3D-CRT plans showed a lower dose to the oesophagus (5.07 Gy) and contralateral breast (V<sub>5</sub> Gy < 15% = 3.51%).</p><p><strong>Conclusion:</strong> It was shown that 3D-CRT and IMRT treatment planning can effectively achieve clinical goals for post-mastectomy left-sided breast cancer radiotherapy.</p><p><strong>Contribution:</strong> The findings underscore the continuing relevance of 3D-CRT planning in oncology for optimal PTV dose coverage and low OAR dose.</p>
2023-06-09T11:40:00+02:00
Copyright (c) 2023 Hesta Friedrich-Nel, Deirdré Long, Nape M. Phahlamohlaka
https://sajo.org.za/index.php/sajo/article/view/252
Succinate dehydrogenase-deficient renal cell carcinoma: A retrospective study, 1999–2018
2023-07-03T15:54:37+02:00
Ella Morrison
ella.morrison13@gmail.com
Jacqueline Goedhals
gnmbjg@ufs.ac.za
Shireen Pretorius
shireen.pretorius@nhls.ac.za
Gina Joubert
gnbsgj@ufs.ac.za
Anthony J. Gill
anthony.james.gill@sydney.edu.au
Gerhard van der Westhuizen
gerhard.vderwesthuizen@pathcare.org
<p><strong>Background:</strong> Succinate dehydrogenase-deficient (SDH-deficient) renal cell carcinoma (RCC) is a rare subtype of RCC. Approximately 0.05% – 0.2% of RCCs are SDH-deficient. It is usually associated with a pathogenic germline variant of the enzyme. Although the tumour is often indolent, it has a strong association with hereditary disease, most commonly paraganglioma and/or pheochromocytoma, and genetic testing is advised. Succinate dehydrogenase-deficient RCC is diagnosed by immunohistochemical (IHC) staining for SDH subunit B (SDHB), with loss of staining confirming SDHB deficiency. The incidence of SDH-deficient RCC in South Africa is unknown.</p><p><strong>Aim:</strong> To determine the incidence of SDH-deficient RCC in the Free State Province and its correlation with the worldwide incidence of 0.05% – 0.2%.</p><p><strong>Setting:</strong> Department of Anatomical Pathology, Universitas Academic Hospital and National Health Laboratory Service (NHLS) in Bloemfontein, South Africa.</p><p><strong>Methods:</strong> A retrospective descriptive study was performed. All primary RCCs diagnosed over a 20-year period (1999–2018) were included. An SDHB IHC stain was performed on all cases. A diagnosis of SDH-deficient RCC required loss of staining in all tumour cells in the presence of internal positive controls.</p><p><strong>Results:</strong> The study included 187 RCC cases. Two cases of SDH-deficient RCC were identified, representing an incidence of 1.1%. Both patients were male and were 22 and 44 years of age, respectively.</p><p><strong>Conclusion:</strong> The incidence of SDH-deficient RCC in central South Africa is slightly higher than global findings.</p><p><strong>Contribution:</strong> This study provides new data on SDH-deficient RCC in the South African context.</p><p> </p>
2023-06-08T10:26:00+02:00
Copyright (c) 2023 Ella Morrison, Jacqueline Goedhals, Shireen Pretorius, Gina Joubert, Anthony Gill, Gerhard van der Westhuizen