Algorithm works to better stage childhood cancer

Australian research has demonstrated the feasibility of implementing the Toronto Childhood Cancer Stage Guidelines within a national cancer registry.

The research, led by Professor Joanne Aitken from Cancer Council Queensland, used data on 1,412 children from the Australian Childhood Cancer Registry who were diagnosed between 2006 and 2010 with one of the 16 cancers in the Toronto guidelines.

Together, the 16 cancers comprise about three quarters of all childhood cancer diagnosed in Australia with ALL, neuroblastoma, AML and non-Hodgkin’s lymphoma being the most common.

For most children (93%), there was sufficient information in the medical records to enable staging according to algorithms based on either basic Tier 1 or more sophisticated Tier 2 criteria.

The study found good agreement for most cancer types between staging with Toronto Tier 2 criteria – designed for high-income countries – and that determined by a panel of expert reviewers (range 84-100%).

Agreement between the algorithm and the expert reviewers was lowest for rhabdomyosarcoma and non-rhabdomyosarcoma soft tissue sarcoma.

They also found the data required for staging via the algorithm could be extracted in a timely manner (mean 11-22 mins) and therefore likely to manageable by most established population cancer registries.

“Our results thus represent a substantial advance in achieving population-wide stage information for childhood cancer compared with what is currently possible,” the authors said.

An accompanying Commentary in Lancet Child and Adolescent Health said reporting clinical stage was historically less straightforward in paediatric versus adult cancer patients.

The consensus-based Toronto guidelines therefore offered an important opportunity to standardise paediatric cancer staging, ‘transform paediatric cancer registration globally, improve our understanding of childhood cancer epidemiology, and provide a unified platform for global monitoring of childhood cancer incidence and outcomes’.

The authors added that application of the Toronto guidelines and Tier 1 criteria has yet to be tested in low and middle-income countries where 80% of children with cancer live.

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