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Papers by Hossam Elzomor

Research paper thumbnail of Ototoxicity in Cisplatin-treated nasopharyngeal carcinoma in children

Fayoum University Medical Journal, Mar 1, 2023

Squamous cell carcinomas are the most common tumors to develop in the head and neck. The pharynge... more Squamous cell carcinomas are the most common tumors to develop in the head and neck. The pharyngeal recess, or fossa of Rosenmuller, is the most typical location of origin [1, 2]. Oncogenesis caused by viruses frequently occurs in head and neck tumors [3]. The precise etiology is still a mystery. However, EBNA1, LMP-1, and LMP-2 viral Abstract Introduction: The most prevalent malignancy, Nasopharyngeal Carcinoma (NPC), occurs at the nasopharynx, affecting men more than women. The standard gold method for the management of patients with NPC is a combination of radiotherapy (RT) and chemotherapy. The most ototoxic and widely used platinum-based chemotherapy in the management of patients with NPC is cisplatin. Aim of the study: To determine the incidence of ototoxicity after chemoradiotherapy in children suffering from nasopharyngeal carcinoma. Subjects and Methods: We enrolled 68 children suffering from nasopharyngeal carcinoma and treated them with chemotherapy or chemoradiotherapy in the time period from 2011 to 2019-50 males and 18 females. We conducted audiometry and tympanometry to assess the hearing system before the start of therapy and after each cycle of treatment with cisplatin. Results: Before, during, and after the chemotherapy cycle, audiometry of the included patients revealed that 33 patients had no hearing loss. The rest were diagnosed with hearing loss (21 patients with SNHL, 9 patients with CHL, and five patients with mixed hearing loss). Hearing evaluation in the right ear showed that 35 patients had no hearing loss, 21 patients had SNHL, 5 patients had CHL, and five patients had mixed hearing loss. Hearing thresholds in the left ear revealed normal hearing in 36 patients, while 22 patients had SNHL, 4 patients had CHL, and four patients had mixed hearing loss. Conclusion: Treatment of NPC with RT and concurrent cisplatin has been shown to cause a significant ototoxic effect, especially with long-term administration of chemoradiotherapy, and the physician should be aware of the possible hearing impairment. The patients should be carefully monitored to prevent the progression and permanent damage to the hearing system

Research paper thumbnail of Outcome of Unilateral Retinoblastoma: A Ten Years Experience of Children's Cancer, Hospital Egypt

World Academy of Science, Engineering and Technology, International Journal of Medical and Health Sciences, Sep 9, 2019

Background: A majority of children with retinoblastoma (60%) have a disease in one eye only (unil... more Background: A majority of children with retinoblastoma (60%) have a disease in one eye only (unilateral disease). This is a retrospective study to evaluate two different treatment modalities in those patients for saving their lives and vision. Methods: Four hundred and four patients were diagnosed with unilateral intraocular retinoblastoma at Children's Cancer, Hospital Egypt (CCHE) through the period of July/2007 until December/2017. Management strategies included primary enucleation versus ocular salvage treatment. Results: Patients presented with mean age 24.5 months with range (1.2-154.3 months). According to the international retinoblastoma classification, Group D (n=172, 42%) was the most common, followed by group E (n=142, 35%), group C (n=63, 16%), and group B (n=27, 7%). All patients were alive at the end of the study except four patients who died, with 5-years overall survival 98.3% [CI, (96.5-100%)]. Patients presented with advanced disease and poor visual prognosis (n=241, 59.6%) underwent primary enucleation with 6 cycles adjuvant chemotherapy if they had highrisk features in the enucleated eye; only four patients out of 241 ended-up either with extraocular metastasis (n=3) or death (n=1). While systemic chemotherapy and focal therapy were the primary treatment for those who presented with favorable disease status and good visual prognosis (n=163, 40.4%); seventy-seven patients of them (47%) ended up with a pre-defined event (enucleation, EBRT, off protocol chemotherapy or 2ry malignancy). Ocular survival for patients received primary chemotherapy + focal therapy was [50.9% (CI, 43.5-59.6%)] at 3 years and [46.9% (CI,39.3-56%)] at 5 years. Comparison between upfront enucleation and primary chemotherapy for occurrence of extraocular metastasis revealed that there was no statistical difference between them except in group D (p value). While for occurrence of death, no statistical difference in all classification groups. Conclusion: In retinoblastoma, primary chemotherapy is a reasonable option and has a good probability for ocular salvage without increasing the risk of metastasis in comparison to upfront enucleation except in group D.

Research paper thumbnail of A multidisciplinary approach to improving the care and outcomes of patients with retinoblastoma at a pediatric cancer hospital in Egypt

Ophthalmic Genetics, Jan 13, 2017

Background: Retinoblastoma poses a substantial burden in developing countries. We conducted this ... more Background: Retinoblastoma poses a substantial burden in developing countries. We conducted this study to assess the effect of implementing a multidisciplinary approach and standardized protocols for treating pediatric patients with retinoblastoma at the Children's Cancer Hospital Egypt (CCHE). Materials and Methods: In January 2011, the CCHE implemented standardized protocols for the diagnosis, treatment, and reporting of retinoblastoma cases. The hospital also introduced a new retinoblastoma management algorithm and data analysis system. In this study, we compared the pathologic features, tumor invasiveness, reporting, and survival of 276 pediatric patients who underwent enucleations of 290 eyes before or after the implementation of the retinoblastoma protocols. Results: Time to enucleation (indicating time needed for decision taking) decreased significantly within the neoadjuvant chemotherapy group for intraocular disease after January 2011 (68.7 ± 48 weeks vs. 47.3 ± 28.3 weeks; p < 0.05). Mean optic nerve stump length increased from 5.6 mm in the earlier period to 7.2 mm in the later period (p = 0.004). The overall quality of pathology reporting also improved during the later period. The probability of 3-year survival was significantly higher for patients during the later period (94.2% vs. 79.2%; p = 0.018). Conclusions: The implementation of standardized protocols and a multidisciplinary approach improved reporting; discrepancies in disease classification and the amount of missing data were reduced; and quality measures and prognostic capabilities of the team were substantially improved. Such established data-driven practice supports faster decision making to enucleate diseased eyes and save patients' lives through providing measurable indicators.

Research paper thumbnail of Ototoxicity in Cisplatin-treated nasopharyngeal carcinoma in children

Fayoum University Medical Journal, Mar 1, 2023

Research paper thumbnail of Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidence

eClinicalMedicine

Background Childhood cancer in low-and middle-income countries is a global health priority, howev... more Background Childhood cancer in low-and middle-income countries is a global health priority, however, the perception that treatment is unaffordable has potentially led to scarce investment in resources, contributing to inferior survival. In this study, we analysed real-world data about the cost-effectiveness of treating 8886 children with cancer at a large resourcelimited paediatric oncology setting in Egypt, between 2013 and 2017, stratified by cancer type, stage/risk, and disease status. Methods Childhood cancer costs (USD 2019) were calculated from a health-system perspective, and 5-year overall survival was used to represent clinical effectiveness. We estimated cost-effectiveness as the cost per disabilityadjusted life-year (cost/DALY) averted, adjusted for utility decrement for late-effect morbidity and mortality. Findings For all cancers combined, cost/DALY averted was $1384 (0.5 × GDP/capita), which is very cost-effective according to WHO-CHOICE thresholds. Ratio of cost/DALY averted to GDP/capita varied by cancer type/sub-type and disease severity (range: 0.1-1.6), where it was lowest for Hodgkin lymphoma, and retinoblastoma, and highest for high-risk acute leukaemia, and high-risk neuroblastoma. Treatment was cost-effective (ratio <3 × GDP/capita) for all cancer types/subtypes and risk/stage groups, except for relapsed/refractory acute leukaemia, and relapsed/progressive patients with brain tumours, hepatoblastoma, Ewing sarcoma, and neuroblastoma. Treatment cost-effectiveness was affected by the high costs and inferior survival of advanced-stage/high-risk and relapsed/progressive cancers. Interpretation Childhood cancer treatment is cost-effective in a resource-limited setting in Egypt, except for some relapsed/progressive cancer groups. We present evidence-based recommendations and lessons to promote highvalue in care delivery, with implications on practice and policy.

Research paper thumbnail of Neuroblastoma-associated Opsoclonous Myoclonous Ataxia Syndrome: Profile and Outcome Report on 15 Egyptian Patients

Journal of Pediatric Hematology/Oncology

Research paper thumbnail of Assessment of Home Accident Among children with Retinoblastoma

Egyptian Journal of Health Care, 2020

Research paper thumbnail of Outcome of Unilateral Retinoblastoma: A Ten Years Experience of Children's Cancer, Hospital Egypt

World Academy of Science, Engineering and Technology, International Journal of Medical and Health Sciences, 2019

Research paper thumbnail of Unilateral retinoblastoma; natural history and an age-based protocol in 248 patients

Eye, 2020

Objectives We aimed to study the clinical state and prognosis of patients with unilateral retinob... more Objectives We aimed to study the clinical state and prognosis of patients with unilateral retinoblastoma who were being treated at a paediatric comprehensive cancer centre in a limited-resource country, to assess the different phases of treatment and the success of different, more complex real-life models. Subjects In this retrospective study, we created a snapshot of our retinoblastoma database for the period between 2007 and 2015. Patients whose data were included in the study were followed up until 2016. Out of a total of 744 screened patients, we included data of 248 patients who had been diagnosed with unilateral retinoblastoma. Results As classified as per the International Retinoblastoma Classification, 1 patient presented with group A, 21 with group B, 39 with group C, 104 with group D and 83 with group E retinoblastoma. Chemotherapy was the initial line of treatment in 115 patients and enucleation in 133 others. Later, 141 patients (56.9%) required further management. Patie...

Research paper thumbnail of 1406 Childhood Orbital Rhabdomyosarcoma. Report from Children's Cancer Hospital-57357-Egypt

European Journal of Cancer, 2015

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 Intern... more This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence Newcastle University ePrints-eprint.ncl.ac.uk

Research paper thumbnail of Clinical presentation of intraocular retinoblastoma; 5-year hospital-based registry in Egypt

Journal of the Egyptian National Cancer Institute, 2015

To study the presenting signs of Retinoblastoma in Egypt at Egypt&amp;amp;amp;amp;amp;amp;amp... more To study the presenting signs of Retinoblastoma in Egypt at Egypt&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s main pediatric oncology referral center. This is a prospective descriptive study (hospital-based registry) conducted at Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Cancer Hospital Egypt between July 2007 and December 2012. Out of 262 patients diagnosed with retinoblastoma, 244 were suffering from intra-ocular disease at presentation. One hundred thirty-nine (57%) patients presented with unilateral disease, while 105 (43%) suffered bilateral disease. The mean age at presentation was 20.6±17months, averaging 18.87±11.76months for bilateral and 25.72±18.78months for unilateral disease. The most common clinical presentation was leukocoria in 180 (73.8%) patients, strabismus in 32 (13.1%) patients and decreased visual acuity in 12 (4.9%) patients. Group D and E disease represented 62% of all affected eyes. Patients with advanced disease (Group C-E) had longer duration of symptoms. In Egypt, retinoblastoma patients present more frequently with advanced disease. There is an ever-increasing need to develop a national team dedicated to studying disease significance and formulating a national awareness program.

Research paper thumbnail of Prevention of Home Accident Among children with Retinoblastoma

Accidents are common among children with retinoblastoma, although these accidents were not adequa... more Accidents are common among children with retinoblastoma, although these accidents were not adequately managed by community. Aim: prevention of home accident among children with retinoblastoma. Design: A quasi experimental design. Setting: at cancer children hospital 57357and parent home. Sampling: A purposeful samples of 100 parents according to specific criteria Tools: three tools were used for data collection. First tool: was an interviewing Questionnaire, (a) Socio – demographic characteristics (b) child health need and problem (c) parent knowledge about retinoblastoma (d) parent knowledge and practice according to prevention of home accident. Second tool: Home environment observation check list for assessing the children home safety. Third tool: medical record analysis regarding diagnosis. Results: The most of parent had satisfactory 'knowledge about prevention of home accident among their children with retinoblastoma, the most of parent had correct practices related prevent...

Research paper thumbnail of Phthisis Bulbi: Clinical and Pathologic Findings in Retinoblastoma

Fetal and pediatric pathology, Jan 3, 2015

Phthisis bulbi represents an ocular end-stage disease characterized by shrinkage and disorganizat... more Phthisis bulbi represents an ocular end-stage disease characterized by shrinkage and disorganization of the eye. We aim at identifying the pathologic changes of phthisis bulbi associated with retinoblastoma. Retrospective observational case series study. 16 enucleated eyes were enrolled retrospectively between 2007 and 2012. Pathologic gross and microscopic findings were assessed. Cases showed grossly shrunken eyes with a mean volume of 4.3 cc. Sclera was markedly thickened in the majority of cases with mean of 2272.8 μ. Choroid showed an average thickness of 1029 μ. Necrosis, dystrophic calcification, ossification, gliosis, residual viable tumor was identified in many cases. Pathologic high risk factors were seen in three specimens. We conclude that retinoblastoma must be considered in the differential diagnosis of phthisis bulbi in the pediatric patients and active tumor was present in half of the patients.

Research paper thumbnail of Temporal trends in childhood cancer survival in Egypt, 2007 to 2017: A large retrospective study of 14 808 children with cancer from the Children's Cancer Hospital Egypt

International Journal of Cancer

Research paper thumbnail of 19 Childhood cancer health outcomes in egypt: ten-year real-world evidence from children’s cancer hospital 57357 – egypt (CCHE) and comparison with results from england

Research paper thumbnail of High Resolution MR Imaging guidelines in retinoblastoma: prospective study correlated with histopathological results

Egyptian Journal of Radiology and Nuclear Medicine

Research paper thumbnail of Survival outcome of intermediate risk neuroblastoma at Children Cancer Hospital Egypt

Journal of the Egyptian National Cancer Institute, 2018

The study aims to evaluate survival outcome in newly diagnosed pediatric intermediate risk neurob... more The study aims to evaluate survival outcome in newly diagnosed pediatric intermediate risk neuroblastoma patients treated at the Children Cancer Hospital - Egypt and their relation to various clinical and pathological factors. The study included stage 3 patients <1.5 years, children 1.5 years or older with stage 3 disease and favorable histopathological features, infants (<1 year) with International Neuroblastoma Staging System (INSS) stage 4 disease, stage 4 children 1-1.5 years with favorable biology, and infants stage 4 s (with unfavorable biologic features). Patients received systemic chemotherapy, in the form of etoposide and carboplatin alternating with cyclophosphamide, doxorubicin and vincristine, administered at 3-week intervals, with a total of 6 or 8 cycles guided by reaching objective overall response (complete/very good partial/partial response). The study included 136 patients, 67 males and 69 females. 101 patients had abdominal primary tumors, 28 had mediastinal...

Research paper thumbnail of Role of surgery in localized initially unresectable neuroblastoma

Journal of pediatric urology, Jan 31, 2018

Evaluating the role of surgery and the extent of tumor resection on the outcome of patients with ... more Evaluating the role of surgery and the extent of tumor resection on the outcome of patients with localized initially unresectable neuroblastoma (NB). This was a retrospective case review study including patients with localized initially unresectable NB. The primary tumor was considered unresectable according to imaging defined risk factors (IDRFs). Surgical resection was attempted after four to six courses of chemotherapy. The extent of resection was classified as follows: ≥90% resection, incomplete resection (50-90%) and cases with <50% resection or just a biopsy. Survival analysis was performed using an intention-to-treat approach. A total of 202 patients with NB were included. Surgical resection was done in 106 patients. It was ≥90% in 89 patients (83.9%). Surgical resection was not performed in 96 patients (47.5%). Fifty-five (57.2%) were in good response after primary chemotherapy and 41 patients (42.7%) had persisting IDRFs, nine of them had biopsy only, and a follow-up str...

Research paper thumbnail of A multidisciplinary approach to improving the care and outcomes of patients with retinoblastoma at a pediatric cancer hospital in Egypt

Ophthalmic Genetics, 2017

Research paper thumbnail of Low-grade Nonrhabdomyosarcoma Soft Tissue Sarcoma: What is Peculiar for Childhood

Journal of pediatric hematology/oncology, Nov 19, 2016

Nearly half of soft tissue sarcomas are nonrhabdomyosarcomas (NRSTSs). The low-grade (LG) form co... more Nearly half of soft tissue sarcomas are nonrhabdomyosarcomas (NRSTSs). The low-grade (LG) form comprises a heterogenous group of diseases that rarely metastasize but are known for local recurrence. The aim of the study was to retrospectively evaluate pediatric LG-NRSTS with regard to demography, survival, and factors affecting outcome in Egyptian patients. The study reviewed 66 NRSTS patients who presented to the Pediatric Oncology Department, National Cancer Institute, Cairo University, between January 2008 and December 2013. Out of the reviewed cases 32 patients had LG tumors and were eligible for analysis. The male to female ratio was 1:1 and the median age was 7.5 years (range, 1 mo to 18 y). Desmoid fibromatosis (N=18) showed frequent local recurrence and nearly half of this group was alive without disease. No recurrence of the disease occurred in the nonfibromatosis group (n=14) and all patients were alive and free of disease. The 5-year overall survival was 88% for the entire...

Research paper thumbnail of Ototoxicity in Cisplatin-treated nasopharyngeal carcinoma in children

Fayoum University Medical Journal, Mar 1, 2023

Squamous cell carcinomas are the most common tumors to develop in the head and neck. The pharynge... more Squamous cell carcinomas are the most common tumors to develop in the head and neck. The pharyngeal recess, or fossa of Rosenmuller, is the most typical location of origin [1, 2]. Oncogenesis caused by viruses frequently occurs in head and neck tumors [3]. The precise etiology is still a mystery. However, EBNA1, LMP-1, and LMP-2 viral Abstract Introduction: The most prevalent malignancy, Nasopharyngeal Carcinoma (NPC), occurs at the nasopharynx, affecting men more than women. The standard gold method for the management of patients with NPC is a combination of radiotherapy (RT) and chemotherapy. The most ototoxic and widely used platinum-based chemotherapy in the management of patients with NPC is cisplatin. Aim of the study: To determine the incidence of ototoxicity after chemoradiotherapy in children suffering from nasopharyngeal carcinoma. Subjects and Methods: We enrolled 68 children suffering from nasopharyngeal carcinoma and treated them with chemotherapy or chemoradiotherapy in the time period from 2011 to 2019-50 males and 18 females. We conducted audiometry and tympanometry to assess the hearing system before the start of therapy and after each cycle of treatment with cisplatin. Results: Before, during, and after the chemotherapy cycle, audiometry of the included patients revealed that 33 patients had no hearing loss. The rest were diagnosed with hearing loss (21 patients with SNHL, 9 patients with CHL, and five patients with mixed hearing loss). Hearing evaluation in the right ear showed that 35 patients had no hearing loss, 21 patients had SNHL, 5 patients had CHL, and five patients had mixed hearing loss. Hearing thresholds in the left ear revealed normal hearing in 36 patients, while 22 patients had SNHL, 4 patients had CHL, and four patients had mixed hearing loss. Conclusion: Treatment of NPC with RT and concurrent cisplatin has been shown to cause a significant ototoxic effect, especially with long-term administration of chemoradiotherapy, and the physician should be aware of the possible hearing impairment. The patients should be carefully monitored to prevent the progression and permanent damage to the hearing system

Research paper thumbnail of Outcome of Unilateral Retinoblastoma: A Ten Years Experience of Children's Cancer, Hospital Egypt

World Academy of Science, Engineering and Technology, International Journal of Medical and Health Sciences, Sep 9, 2019

Background: A majority of children with retinoblastoma (60%) have a disease in one eye only (unil... more Background: A majority of children with retinoblastoma (60%) have a disease in one eye only (unilateral disease). This is a retrospective study to evaluate two different treatment modalities in those patients for saving their lives and vision. Methods: Four hundred and four patients were diagnosed with unilateral intraocular retinoblastoma at Children's Cancer, Hospital Egypt (CCHE) through the period of July/2007 until December/2017. Management strategies included primary enucleation versus ocular salvage treatment. Results: Patients presented with mean age 24.5 months with range (1.2-154.3 months). According to the international retinoblastoma classification, Group D (n=172, 42%) was the most common, followed by group E (n=142, 35%), group C (n=63, 16%), and group B (n=27, 7%). All patients were alive at the end of the study except four patients who died, with 5-years overall survival 98.3% [CI, (96.5-100%)]. Patients presented with advanced disease and poor visual prognosis (n=241, 59.6%) underwent primary enucleation with 6 cycles adjuvant chemotherapy if they had highrisk features in the enucleated eye; only four patients out of 241 ended-up either with extraocular metastasis (n=3) or death (n=1). While systemic chemotherapy and focal therapy were the primary treatment for those who presented with favorable disease status and good visual prognosis (n=163, 40.4%); seventy-seven patients of them (47%) ended up with a pre-defined event (enucleation, EBRT, off protocol chemotherapy or 2ry malignancy). Ocular survival for patients received primary chemotherapy + focal therapy was [50.9% (CI, 43.5-59.6%)] at 3 years and [46.9% (CI,39.3-56%)] at 5 years. Comparison between upfront enucleation and primary chemotherapy for occurrence of extraocular metastasis revealed that there was no statistical difference between them except in group D (p value). While for occurrence of death, no statistical difference in all classification groups. Conclusion: In retinoblastoma, primary chemotherapy is a reasonable option and has a good probability for ocular salvage without increasing the risk of metastasis in comparison to upfront enucleation except in group D.

Research paper thumbnail of A multidisciplinary approach to improving the care and outcomes of patients with retinoblastoma at a pediatric cancer hospital in Egypt

Ophthalmic Genetics, Jan 13, 2017

Background: Retinoblastoma poses a substantial burden in developing countries. We conducted this ... more Background: Retinoblastoma poses a substantial burden in developing countries. We conducted this study to assess the effect of implementing a multidisciplinary approach and standardized protocols for treating pediatric patients with retinoblastoma at the Children's Cancer Hospital Egypt (CCHE). Materials and Methods: In January 2011, the CCHE implemented standardized protocols for the diagnosis, treatment, and reporting of retinoblastoma cases. The hospital also introduced a new retinoblastoma management algorithm and data analysis system. In this study, we compared the pathologic features, tumor invasiveness, reporting, and survival of 276 pediatric patients who underwent enucleations of 290 eyes before or after the implementation of the retinoblastoma protocols. Results: Time to enucleation (indicating time needed for decision taking) decreased significantly within the neoadjuvant chemotherapy group for intraocular disease after January 2011 (68.7 ± 48 weeks vs. 47.3 ± 28.3 weeks; p < 0.05). Mean optic nerve stump length increased from 5.6 mm in the earlier period to 7.2 mm in the later period (p = 0.004). The overall quality of pathology reporting also improved during the later period. The probability of 3-year survival was significantly higher for patients during the later period (94.2% vs. 79.2%; p = 0.018). Conclusions: The implementation of standardized protocols and a multidisciplinary approach improved reporting; discrepancies in disease classification and the amount of missing data were reduced; and quality measures and prognostic capabilities of the team were substantially improved. Such established data-driven practice supports faster decision making to enucleate diseased eyes and save patients' lives through providing measurable indicators.

Research paper thumbnail of Ototoxicity in Cisplatin-treated nasopharyngeal carcinoma in children

Fayoum University Medical Journal, Mar 1, 2023

Research paper thumbnail of Cost-effectiveness of childhood cancer treatment in Egypt: Lessons to promote high-value care in a resource-limited setting based on real-world evidence

eClinicalMedicine

Background Childhood cancer in low-and middle-income countries is a global health priority, howev... more Background Childhood cancer in low-and middle-income countries is a global health priority, however, the perception that treatment is unaffordable has potentially led to scarce investment in resources, contributing to inferior survival. In this study, we analysed real-world data about the cost-effectiveness of treating 8886 children with cancer at a large resourcelimited paediatric oncology setting in Egypt, between 2013 and 2017, stratified by cancer type, stage/risk, and disease status. Methods Childhood cancer costs (USD 2019) were calculated from a health-system perspective, and 5-year overall survival was used to represent clinical effectiveness. We estimated cost-effectiveness as the cost per disabilityadjusted life-year (cost/DALY) averted, adjusted for utility decrement for late-effect morbidity and mortality. Findings For all cancers combined, cost/DALY averted was $1384 (0.5 × GDP/capita), which is very cost-effective according to WHO-CHOICE thresholds. Ratio of cost/DALY averted to GDP/capita varied by cancer type/sub-type and disease severity (range: 0.1-1.6), where it was lowest for Hodgkin lymphoma, and retinoblastoma, and highest for high-risk acute leukaemia, and high-risk neuroblastoma. Treatment was cost-effective (ratio <3 × GDP/capita) for all cancer types/subtypes and risk/stage groups, except for relapsed/refractory acute leukaemia, and relapsed/progressive patients with brain tumours, hepatoblastoma, Ewing sarcoma, and neuroblastoma. Treatment cost-effectiveness was affected by the high costs and inferior survival of advanced-stage/high-risk and relapsed/progressive cancers. Interpretation Childhood cancer treatment is cost-effective in a resource-limited setting in Egypt, except for some relapsed/progressive cancer groups. We present evidence-based recommendations and lessons to promote highvalue in care delivery, with implications on practice and policy.

Research paper thumbnail of Neuroblastoma-associated Opsoclonous Myoclonous Ataxia Syndrome: Profile and Outcome Report on 15 Egyptian Patients

Journal of Pediatric Hematology/Oncology

Research paper thumbnail of Assessment of Home Accident Among children with Retinoblastoma

Egyptian Journal of Health Care, 2020

Research paper thumbnail of Outcome of Unilateral Retinoblastoma: A Ten Years Experience of Children's Cancer, Hospital Egypt

World Academy of Science, Engineering and Technology, International Journal of Medical and Health Sciences, 2019

Research paper thumbnail of Unilateral retinoblastoma; natural history and an age-based protocol in 248 patients

Eye, 2020

Objectives We aimed to study the clinical state and prognosis of patients with unilateral retinob... more Objectives We aimed to study the clinical state and prognosis of patients with unilateral retinoblastoma who were being treated at a paediatric comprehensive cancer centre in a limited-resource country, to assess the different phases of treatment and the success of different, more complex real-life models. Subjects In this retrospective study, we created a snapshot of our retinoblastoma database for the period between 2007 and 2015. Patients whose data were included in the study were followed up until 2016. Out of a total of 744 screened patients, we included data of 248 patients who had been diagnosed with unilateral retinoblastoma. Results As classified as per the International Retinoblastoma Classification, 1 patient presented with group A, 21 with group B, 39 with group C, 104 with group D and 83 with group E retinoblastoma. Chemotherapy was the initial line of treatment in 115 patients and enucleation in 133 others. Later, 141 patients (56.9%) required further management. Patie...

Research paper thumbnail of 1406 Childhood Orbital Rhabdomyosarcoma. Report from Children's Cancer Hospital-57357-Egypt

European Journal of Cancer, 2015

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 Intern... more This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence Newcastle University ePrints-eprint.ncl.ac.uk

Research paper thumbnail of Clinical presentation of intraocular retinoblastoma; 5-year hospital-based registry in Egypt

Journal of the Egyptian National Cancer Institute, 2015

To study the presenting signs of Retinoblastoma in Egypt at Egypt&amp;amp;amp;amp;amp;amp;amp... more To study the presenting signs of Retinoblastoma in Egypt at Egypt&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s main pediatric oncology referral center. This is a prospective descriptive study (hospital-based registry) conducted at Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Cancer Hospital Egypt between July 2007 and December 2012. Out of 262 patients diagnosed with retinoblastoma, 244 were suffering from intra-ocular disease at presentation. One hundred thirty-nine (57%) patients presented with unilateral disease, while 105 (43%) suffered bilateral disease. The mean age at presentation was 20.6±17months, averaging 18.87±11.76months for bilateral and 25.72±18.78months for unilateral disease. The most common clinical presentation was leukocoria in 180 (73.8%) patients, strabismus in 32 (13.1%) patients and decreased visual acuity in 12 (4.9%) patients. Group D and E disease represented 62% of all affected eyes. Patients with advanced disease (Group C-E) had longer duration of symptoms. In Egypt, retinoblastoma patients present more frequently with advanced disease. There is an ever-increasing need to develop a national team dedicated to studying disease significance and formulating a national awareness program.

Research paper thumbnail of Prevention of Home Accident Among children with Retinoblastoma

Accidents are common among children with retinoblastoma, although these accidents were not adequa... more Accidents are common among children with retinoblastoma, although these accidents were not adequately managed by community. Aim: prevention of home accident among children with retinoblastoma. Design: A quasi experimental design. Setting: at cancer children hospital 57357and parent home. Sampling: A purposeful samples of 100 parents according to specific criteria Tools: three tools were used for data collection. First tool: was an interviewing Questionnaire, (a) Socio – demographic characteristics (b) child health need and problem (c) parent knowledge about retinoblastoma (d) parent knowledge and practice according to prevention of home accident. Second tool: Home environment observation check list for assessing the children home safety. Third tool: medical record analysis regarding diagnosis. Results: The most of parent had satisfactory 'knowledge about prevention of home accident among their children with retinoblastoma, the most of parent had correct practices related prevent...

Research paper thumbnail of Phthisis Bulbi: Clinical and Pathologic Findings in Retinoblastoma

Fetal and pediatric pathology, Jan 3, 2015

Phthisis bulbi represents an ocular end-stage disease characterized by shrinkage and disorganizat... more Phthisis bulbi represents an ocular end-stage disease characterized by shrinkage and disorganization of the eye. We aim at identifying the pathologic changes of phthisis bulbi associated with retinoblastoma. Retrospective observational case series study. 16 enucleated eyes were enrolled retrospectively between 2007 and 2012. Pathologic gross and microscopic findings were assessed. Cases showed grossly shrunken eyes with a mean volume of 4.3 cc. Sclera was markedly thickened in the majority of cases with mean of 2272.8 μ. Choroid showed an average thickness of 1029 μ. Necrosis, dystrophic calcification, ossification, gliosis, residual viable tumor was identified in many cases. Pathologic high risk factors were seen in three specimens. We conclude that retinoblastoma must be considered in the differential diagnosis of phthisis bulbi in the pediatric patients and active tumor was present in half of the patients.

Research paper thumbnail of Temporal trends in childhood cancer survival in Egypt, 2007 to 2017: A large retrospective study of 14 808 children with cancer from the Children's Cancer Hospital Egypt

International Journal of Cancer

Research paper thumbnail of 19 Childhood cancer health outcomes in egypt: ten-year real-world evidence from children’s cancer hospital 57357 – egypt (CCHE) and comparison with results from england

Research paper thumbnail of High Resolution MR Imaging guidelines in retinoblastoma: prospective study correlated with histopathological results

Egyptian Journal of Radiology and Nuclear Medicine

Research paper thumbnail of Survival outcome of intermediate risk neuroblastoma at Children Cancer Hospital Egypt

Journal of the Egyptian National Cancer Institute, 2018

The study aims to evaluate survival outcome in newly diagnosed pediatric intermediate risk neurob... more The study aims to evaluate survival outcome in newly diagnosed pediatric intermediate risk neuroblastoma patients treated at the Children Cancer Hospital - Egypt and their relation to various clinical and pathological factors. The study included stage 3 patients <1.5 years, children 1.5 years or older with stage 3 disease and favorable histopathological features, infants (<1 year) with International Neuroblastoma Staging System (INSS) stage 4 disease, stage 4 children 1-1.5 years with favorable biology, and infants stage 4 s (with unfavorable biologic features). Patients received systemic chemotherapy, in the form of etoposide and carboplatin alternating with cyclophosphamide, doxorubicin and vincristine, administered at 3-week intervals, with a total of 6 or 8 cycles guided by reaching objective overall response (complete/very good partial/partial response). The study included 136 patients, 67 males and 69 females. 101 patients had abdominal primary tumors, 28 had mediastinal...

Research paper thumbnail of Role of surgery in localized initially unresectable neuroblastoma

Journal of pediatric urology, Jan 31, 2018

Evaluating the role of surgery and the extent of tumor resection on the outcome of patients with ... more Evaluating the role of surgery and the extent of tumor resection on the outcome of patients with localized initially unresectable neuroblastoma (NB). This was a retrospective case review study including patients with localized initially unresectable NB. The primary tumor was considered unresectable according to imaging defined risk factors (IDRFs). Surgical resection was attempted after four to six courses of chemotherapy. The extent of resection was classified as follows: ≥90% resection, incomplete resection (50-90%) and cases with <50% resection or just a biopsy. Survival analysis was performed using an intention-to-treat approach. A total of 202 patients with NB were included. Surgical resection was done in 106 patients. It was ≥90% in 89 patients (83.9%). Surgical resection was not performed in 96 patients (47.5%). Fifty-five (57.2%) were in good response after primary chemotherapy and 41 patients (42.7%) had persisting IDRFs, nine of them had biopsy only, and a follow-up str...

Research paper thumbnail of A multidisciplinary approach to improving the care and outcomes of patients with retinoblastoma at a pediatric cancer hospital in Egypt

Ophthalmic Genetics, 2017

Research paper thumbnail of Low-grade Nonrhabdomyosarcoma Soft Tissue Sarcoma: What is Peculiar for Childhood

Journal of pediatric hematology/oncology, Nov 19, 2016

Nearly half of soft tissue sarcomas are nonrhabdomyosarcomas (NRSTSs). The low-grade (LG) form co... more Nearly half of soft tissue sarcomas are nonrhabdomyosarcomas (NRSTSs). The low-grade (LG) form comprises a heterogenous group of diseases that rarely metastasize but are known for local recurrence. The aim of the study was to retrospectively evaluate pediatric LG-NRSTS with regard to demography, survival, and factors affecting outcome in Egyptian patients. The study reviewed 66 NRSTS patients who presented to the Pediatric Oncology Department, National Cancer Institute, Cairo University, between January 2008 and December 2013. Out of the reviewed cases 32 patients had LG tumors and were eligible for analysis. The male to female ratio was 1:1 and the median age was 7.5 years (range, 1 mo to 18 y). Desmoid fibromatosis (N=18) showed frequent local recurrence and nearly half of this group was alive without disease. No recurrence of the disease occurred in the nonfibromatosis group (n=14) and all patients were alive and free of disease. The 5-year overall survival was 88% for the entire...