[Downloaded free from http://www.ijmpo.org on Wednesday, January 16, 2019, IP: 202.43.93.

18]

Original Article

A Profile of Pediatric Solid Tumors: A Single Institution Experience in

Kashmir

Abstract Namita Sharma,

Aims: The purpose of this retroprospective study was to study the epidemiological characteristics Ayesha Ahmad1,
and outcomes of children with solid tumors at our institution. Subjects and Methods: Three Gull M Bhat,
hundred and three pediatrics patients registered at Regional Cancer Centre (RCC), Sher‑i‑Kashmir
Institute of Medical Sciences (SKIMS), Srinagar, Kashmir, between January 2008 and June Sheikh A Aziz,
2014, were analyzed with regard to demographic status, presenting complaints, investigations, Mohammad
treatment, morbidity, and outcomes. Standard statistical methods were used for analysis. Results: Maqbool Lone2,
Among 19,880 patients registered at RCC, SKIMS from January 2008 till June 2014, 986 (4.9%) Nisar A Bhat3
were of pediatric age group. Of these, 303 (30.7%) patients had pediatric solid tumors. The Departments of Medical
male‑to‑female ratio was 1.04, there were no infants (up to 27 days), 6% were infants and toddlers Oncology, 2Radiation Oncology
(28 days–23 months), 39% were children (2–11 years), and 55% were adolescents (12–19 years). and 3Paediatric Surgery,
There were 86% rural patients and 14% urban patients. Most common were central nervous system Sher‑i‑Kashmir Institute of
tumors (25.74%), followed by germ cell tumors (14.52%), primitive neuroectodermal tumor/Ewing Medical Sciences, Srinagar,
sarcoma (13.86%), Wilms’ tumor (8.9%), osteosarcoma (6.6%), rhabdomyosarcoma (5.6%), Jammu and Kashmir,
colorectal cancer (5.28%), neuroblastoma (4.9%), and retinoblastoma (2.6%). Outcomes: 33.9%
1
Department of Paediatrics,
Jawaharlal Nehru Medical
patients went into remission, 35.64% were defaulters, 2.97% had stable disease, 2.31% had partial
College and Hospital, Aligarh
response, 20.79% expired, and 3.96% were still on treatment. Of all these patients, 5.28% had a Muslim University, Aligarh,
relapse. Conclusions: Across the series, advanced stage of presentation, a high incidence of default Uttar Pradesh, India
and poor follow‑up was seen. Multiple interrelated factors are responsible for the poorer outlook of
childhood cancer in Kashmir.

Keywords: Epidemiologic profile, outcomes of treatment, pediatric solid tumors

Introduction Dramatic improvements in survival have

been achieved in children and adolescents
Cancer in children and adolescents is rare
with cancer. Between 1975 and 2010,
although the overall incidence of childhood
childhood cancer mortality decreased
cancer has been slowly increasing since
by >50%.[11] This success can be attributed
1975.[1] Worldwide, the annual number of
to several factors. These include enrollment
new childhood cancer exceeds 200,000
of patients into well‑designed prospective
and >80% of these are from the developing
clinical trials, systematic collection of tissue
world.[1] Seven out of 10 children with
to better define the biology of disease,
cancer in the resource rich countries
availability of more effective chemotherapy Address for correspondence:
are cured, with 5‑year survival rates
agents, use of multimodal therapy, better Dr. Namita Sharma,
for certain cancers such as Hodgkin’s
supportive care, and more refined diagnostic Room No. 1301, Department
lymphoma and retinoblastoma approaching of Medical Oncology,
imaging methods that accurately define the
95%.[2,3] Recent studies have shown that Sher‑i‑Kashmir Institute
extent of disease. of Medical Sciences,
this success in survival can be replicated
Data regarding cancer incidence are Soura, Srinagar ‑ 190 011,
in the developing world through shared Jammu and Kashmir, India.
expertise.[4‑7] Childhood cancer remains the important for several reasons. Cancer E‑mail: sharma.namita@
leading cause of disease‑related mortality in affects all nations, and therefore, it is hotmail.com
children.[8] Malignant solid tumors account an endemic disease with considerable
for approximately 30% of childhood variation in frequency according to the site
cancers.[9] The predominant histology of incidence. The geographical differences Access this article online

specific solid tumors varies significantly in total and site incidences have provided Website: www.ijmpo.org
with age.[10] clues of causative factors and especially in DOI: 10.4103/ijmpo.ijmpo_95_16
separating environmental and ethnic factors Quick Response Code:
This is an open access article distributed under the terms of the from intrinsic factors. As we make progress
Creative Commons Attribution-NonCommercial-ShareAlike 3.0
License, which allows others to remix, tweak, and build upon the
work non-commercially, as long as the author is credited and the How to cite this article: Sharma N, Ahmad A, Bhat GM,
new creations are licensed under the identical terms. Aziz SA, Lone MM, Bhat NA. A profile of pediatric solid
tumors: A single institution experience in Kashmir.
For reprints contact: [email protected] Indian J Med Paediatr Oncol 2017;38:471-7.

© 2017 Indian Journal of Medical and Paediatric Oncology | Published by Wolters Kluwer ‑ Medknow 471
[Downloaded free from http://www.ijmpo.org on Wednesday, January 16, 2019, IP: 202.43.93.18]

Sharma, et al.: Profile of pediatric solid tumors

in reducing infection‑related childhood deaths in India, Results

it is imperative to give attention to children with cancer,
Demographic data
who have an increasing likelihood of cure with appropriate
treatment. A total of 19,880 patients were registered at RCC, SKIMS,
Sher‑i‑Kashmir Institute of medical sciences (SKIMS), from January 2008 till June 2014. Among these patients,
Srinagar is a 700‑bedded tertiary care teaching hospital in 986 (4.9%) were of pediatric age group. And of these,
Jammu and Kashmir. A Regional Cancer Centre (RCC) was 303 (30.7%) patients had pediatric solid tumors [Table 1].
established at SKIMS, under the national cancer control All subsequent data are for the patients with pediatric
program with the objective to provide cancer treatment solid tumors. There were 51% male and 49% females
facilities in addition to cancer prevention programs across (M:F ratio was 1.04:1) [Figure 1]. There were no
the state. In this study, we aimed to retroprospectively study infants (up to 27 days), 6% were infants and toddlers
the epidemiological characteristics, treatments received, and (28 days–23 months), 39% were children (2–11 years), and
outcomes of children with solid tumors at RCC, SKIMS. 55% were adolescents (12–19 years). There were 86% rural
Based on our study, we could better evaluate the status of patients and 14% urban patients. Most patients (47%) were
our efforts to treat this subgroup of patients and deliver from Budgam district followed by Baramulla (44%) and
improved care. Srinagar district (43%).
Subjects and Methods Tumor distribution
A retroprospective study was conducted in 303 pediatric The most frequent were central nervous system (CNS)
patients (children and adolescents up to 19 years of age) tumors (25.74%) followed by (in descending
with histologically proven solid tumors who were registered order of frequency) germ cell tumors (14.52%),
at RCC, SKIMS, Srinagar, between January 2008 to June primitive neuroectodermal tumor (PNET)/Ewing
2014. A research protocol for this study was approved by sarcoma (ES) (13.86%), Wilms’ tumor (8.9%),
the local Ethics Committee and informed consents were osteosarcoma (6.6%), rhabdomyosarcoma (5.6%),
taken from each patient’s parent/guardian. colorectal cancer (5.28%), neuroblastoma (4.9%), and
A pro forma was developed, and patient characteristics retinoblastoma (2.6%) [Table 2 and Figure 2].
with regard to age, sex, locality, residence, type of family,
socioeconomic status, clinical presentation, investigations, 30
CNS tumors Germ cell tumor PNET/ES
treatment prescribed, and any morbidity in each case were Wilms Tumor
Colorectal cancer
Osteosarcoma
Neuroblastoma
Rhabdomyosarcoma
Retinoblastoma
studied in detail.
22.5
Following completion of treatment, the patients were
followed up in our outpatient department. The frequency
of follow‑up visits was according to their individual 15

tumor type and general recommendations. In each visit,

a detailed history and physical examination and relevant
investigations were done to detect any late side effects of 7.5

treatment or relapse. The last follow‑up studied was till

January 2015.
0
Percentage (%)
Standard statistical methods were used for statistical
analysis. Figure 1: Age distribution

Table 1: Pediatric patients registered at Regional Cancer Centre, Sher‑i‑Kashmir Institute of medical sciences from
January 2008 to June 2014
Year Number of pediatric patients registered at RCC Number of pediatric patients with Percentage of pediatric patients
(up to 19 years of age) solid tumors with solid tumors (%)
2008 136 24 17.6
2009 140 30 21.4
2010 140 25 17.8
2011 146 51 34.9
2012 174 65 37.3
2013 166 73 43.9
Till mid 2014 84 35 41.6
Total 986 303 30.7
RCC – Regional Cancer Center

472 Indian Journal of Medical and Paediatric Oncology | Volume 38 | Issue 4 | October-December 2017
[Downloaded free from http://www.ijmpo.org on Wednesday, January 16, 2019, IP: 202.43.93.18]

Sharma, et al.: Profile of pediatric solid tumors

Table 2: Major tumor distribution

Major tumor CNS Germ cell PNET/ES Wilms Osteosarcoma Rhabdomyosarcoma Colorectal Neuroblastoma Retinoblastoma
distribution tumors tumor tumor cancer
Percentage 25.74 14.52 13.86 8.9 6.6 5.6 5.28 4.9 2.6
PNET – Primitive neuroectodermal tumor; ES – Ewing sarcoma; CNS – Central nervous system

Table 3: Overall outcomes Preterm infants Term infants(0-27 days)

Outcome Number of patients (%) Infants and toddlers(28 days-23 months) Children (2-11years)
Remission 103 (33.9) Adolescents(12-19 years)
Defaulter 108 (35.64)
Persistent disease 9 (2.97) 0% 0%

Partial response 7 (2.31) 6%

On treatment 12 (3.96)
Expired 63 (20.79)
Relapse (total patients) 16 (5.28)

Outcome 39%
55%
Among the 303 patients studied, 33.9% patients went
into remission, 35.64% were defaulters, 2.97% had stable
disease, 2.31% had partial response, 20.79% expired, and
3.96% were still on treatment. Of all these patients 5.28%
had a relapse [Table 3].
Morbidity
Figure 2: Major tumor distribution
Among the documented morbidities, the most common was
febrile neutropenia (9.2%) followed by chronic hepatitis CNS/spine. Most patients defaulted (40%), remission
B (1.6%). was documented in 24%, stable disease in 7%, partial
Individual tumor characteristics response in 2% and 19% expired
• Wilms’ tumor  (n‑27): These constituted 90% of renal
• Table 4 summarizes the characteristics of pediatric solid tumors. They were more common in males (59.2%)
tumors in our study population CNS tumors (n‑78): and mostly presented in children in the age group of
These were more frequent in males (59%) and in 2–11 years (81.4%). Most of the tumors were diagnosed
adolescents (55%). The most common histology was in Stage III (44.4%), followed by Stage I (29.6%), stage
astrocytoma (25.64%) and WHO Grade IV (26.9%) IV (22.2%), and Stage II (3.7%). Most patients went
though in 42.3% cases grade was not mentioned. Most
into remission (55.5%), 25.9% defaulted, 3.7% had
patients defaulted (48.7%), remission was documented
stable disease, and 11.1% expired
in 16.6%, stable disease in 1.2%, partial response in
• Osteosarcoma  (n‑20): These were equally prevalent
6.4%, and 23% expired
in males and females. Most were diagnosed in
• Germ cell tumors  (n‑44): These were more frequent
adolescents (80%) and in localized stage (90%). Most
in females (68%) and adolescents (66%). The most
common histologies were yolk sac tumors (23%) patients went into remission (50%), but 35% defaulted,
and dysgerminoma (23%) followed by mixed 10% were still on treatment, and 5% expired
germ cell tumor (20%), teratoma (immature 11%, • Rhabdomyosarcoma  (n‑17): They were more common
mature 5%), and seminoma (2.2%). According to in males (71%) and in children in the age group of
site, 75% were gonadal, 9% were extra‑gonadal, and 2–11 years (59%) followed by adolescents (41%)
16% were in CNS/spine (germinomas). Most patients and none in infants up to 23 months. The most
were diagnosed in Stage I/III (41% each) then Stage common histology was embryonal (53%), followed
IV (16%) and Stage II (2.2%). Most of the patients by alveolar (24%), and pleomorphic (6%) and
achieved remission (66%) but 30% defaulted and 2.2% others (18%). Most of the tumors were diagnosed in
expired Stage IV (47%) followed by Stage I (29%), Stage
• PNET/ES  (n‑42): These were more frequent in II/III (12% each). Most patients defaulted (59%), 18%
males (55%) and in adolescents (79%). Localized went into remission, 12% had stable disease, and 12%
tumors were marginally more frequent (52.8%) as expired
compared to metastatic disease (47.2%). According to • Colorectal carcinoma (n‑16): These were more frequent
site, 48% were extraosseous, 38% osseous, and 14% in in females (56%), and all were adolescents (100%).
Indian Journal of Medical and Paediatric Oncology | Volume 38 | Issue 4 | October-December 2017 473
474
Table 4: Characteristics of the pediatric solid tumors in the study population
Tumors Age distribution Site distribution Histology Outcomes (total)
Up to 2-11 years 12-19 years Remission Defaulter Persistent Partial On Expired
23 months disease response treatment
CNS (male: 46; female: 32) 1 34 43
Germ cell tumor (male: 14; female: 30) 4 11 29 Gonadal: 33 Yolk sac: 10 29 13 0 0 1 1
Extragonadal: 4 Dysgerminoma: 10
CNS: 7 Seminoma: 1
Immature teratoma: 5
Mature teratoma: 2
Mixed: 9
Germinoma: 7
PNET/ES (male: 23; female: 19) 1 8 33 Osseous: 16 10 17 3 1 3 8
Extraosseous: 20
Brain/spine: 6
Osteosarcoma (male: 10; female: 10) 0 4 16 Localized: 18 10 7 0 0 2 1
Metastatic: 2
Renal tumors
Wilm’s tumor (male: 16; female: 11) 5 22 0 15 7 1 0 1 3
Reninoma (male: 1; female: 0) 0 1 0 1 0 0 0 0 0
[Downloaded free from http://www.ijmpo.org on Wednesday, January 16, 2019, IP: 202.43.93.18]

Renal cell CA (male: 1; female: 1) 0 0 2 1 0 0 0 0 1

Sharma, et al.: Profile of pediatric solid tumors

Neuroblastoma (male: 11; female: 4) 4 9 2 1 5 1 0 0 8

Retinoblastoma (male: 5; female: 3) 2 6 0 Unilateral: 5 2 4 0 0 0 2
Bilateral: 3
Rhabdomyosarcoma (male: 12; female: 5) 0 10 7 Embryonal: 9 3 10 2 0 0 2
Alveolar: 4
Pleomorphic: 1
Others: 3
Hepatoblastoma (male: 1; female: 2) 1 2 0 3 0 0 0 0 0
Colorectal carcinoma (male: 7; female: 9) 0 0 16 0 2 0 0 0 14
PNET – Primitive neuroectodermal tumor; ES – Ewing sarcoma; CNS – Central nervous system

Indian Journal of Medical and Paediatric Oncology | Volume 38 | Issue 4 | October-December 2017

[Downloaded free from http://www.ijmpo.org on Wednesday, January 16, 2019, IP: 202.43.93.18]

Sharma, et al.: Profile of pediatric solid tumors

Most patients were diagnosed in Stage III (50%) or are few studies reporting childhood cancer incidence from
Stage IV (44%) followed by Stage II (6%) and none cancer registries in Indian states. A recent publication by
in Stage I. Most of the patients expired (88%), and the Satyanarayana et al. provides an updated summary overview
rest (13%) defaulted of the incidence of childhood cancer on the basis of the
• Neuroblastoma  (n‑15): They were more common in 2013 report from the National Cancer Registry Program
males (73%) and mostly presented in children in the for the years 2006–2011 that covered 25 population‑based
age group of 2–11 years (60%) followed by infants cancer registries in India.[16] In low‑ and middle‑income
up to 23 months (27%) and children in 12–19 years countries, where 80% of children live, the 200,000 children
age group (13%). Most of the tumors were diagnosed diagnosed with cancer each year have limited access to
in Stage IV (73%), followed by Stage III (20%), curative treatment and only about 25% survive.[17] The
stage I (7%), and none in Stage II. Most patients difference in survival for children diagnosed with cancer
expired (53%), 33% defaulted, only 7% had remission, between high‑ and low‑income countries continues to
and 7% had stable disease widen as curative therapies are developed in the former but
• Retinoblastoma  (n‑8): They were more common in not implemented in the latter.[18]
males (62%) and mostly presented in children in the
Overall, cancer in childhood is more common among
age group of 2–11 years (75%) followed by infants
males than females, and the male‑to‑female ratio in the
up to 23 months (25%) and none in the 12–19 years
most resource‑rich countries is around 1.2:1.[3,19] However,
age group. Among these, 63% were unilateral and
some cancers such as retinoblastoma, Wilms’ tumor,
38% bilateral. Most of the tumors were diagnosed
osteosarcoma, and germ cell tumor show a slight female
in Reese‑Ellsworth Group II (38%), followed by
preponderance. The reported incidence of childhood cancer
Group III (25%), Group IV (25%), and Group I (13%). in India in males (39–150 per million children per year) is
Most patients defaulted (50%), 25% went into remission higher than in females (23–97 per million children per year)
and 25% expired in all population‑based cancer registries (PBCRs) except
• Hepatoblastoma  (n‑3): These were more frequent in North East India, and this gives a male‑to‑female ratio
in females (67%) and in children in 2–11 years age that is much higher than what is seen in the developed
group (67%) followed by infants up to 23 months (33%) world.
and none among the adolescents. Most patients
were diagnosed in Stage I (67%), followed by Stage Outcomes approaching similar to international standards
IV (33%), and none in Stage II/III. All the patients have been achieved in India in those treated at tertiary
achieved remission (100%) institutes like the Tata Memorial Hospital in Mumbai
• Benign tumors  (n‑17): These were rare as per the available literature.[20] However, one cannot
cases  –  fibromatosis  (n‑1, remission), giant cell extrapolate these results to the whole population as often
tumor of bone (n‑2, 1 remission, 1 stable disease), those who abandon treatment or are lost to follow‑up are
inflammatory myofibromatosis  (n‑2, remission), excluded from the analysis of hospital case series, and such
meningioma (n‑1, defaulted), Langerhans cell patients may have a more advanced disease and a poorer
histiocytosis (n‑7, 3 remissions, 4 defaulters), outlook. PBCR survival data are a better representation of
schwannoma (n‑3, 2 defaulters, 1 stable disease) and cancer outcomes across India and have been reported from
vascular hamartoma (n‑1, defaulter). Bangalore and Chennai where the 5‑year overall survival
for all childhood cancers combined is 37‑40%. The highest
Discussion survival is seen for Wilms’ tumor and Hodgkins’ lymphoma
where approximately two‑third of the children survive
Malignancy is the second most common cause of childhood
for 5 years or more. The survival for retinoblastoma
death in the developed world, accounting for 10%–12.3%
and germ cell tumors, which are cancers with excellent
of all childhood deaths.[11] Although child health continues
prognosis in the developed world is disappointingly low
to be a priority health issue in India, childhood cancer is
and may be related to an advanced stage at presentation
not yet a major area of focus. Appropriate management
and suboptimal chemotherapy regimens used.[21,22] The
of pediatric tumors requires complete epidemiological
prognosis for leukemia and CNS tumors are also low
data of pediatric tumors in different geographical areas.
where approximately only 33% and 25% of the children
In developing countries, as significant progress is made
survive at 5 years.
in treating infectious diseases and nutritional deficiencies,
cancer is emerging as a major childhood killer.[12,13] Pediatric solid tumors in Kashmir: Available data
In India, cancer is the 9  common cause for the deaths
th
One of the earliest reports regarding the pediatric
among children between 5 and 14 years of age.[14] The solid tumors in Kashmir was published by Shah A in
proportion of childhood cancers relative to all cancers 1992.[23] This study did a retrospective analysis of 93 cases
reported by Indian cancer registries varied from 0.8% to of childhood tumors (except leukemias) received in the
5.8% in boys and from 0.5% to 3.4% in girls.[15] There Department of pathology during January 1983 to June

Indian Journal of Medical and Paediatric Oncology | Volume 38 | Issue 4 | October-December 2017 475
[Downloaded free from http://www.ijmpo.org on Wednesday, January 16, 2019, IP: 202.43.93.18]

Sharma, et al.: Profile of pediatric solid tumors

1989. These 93 cases formed 0.1% of total hospital achieved remission, and 20.79% patients expired over the
admissions, 4.3% of pediatric admissions and 1.7% of study duration. It is clear that the patients in Jammu and
all malignant tumors. Lymphoma was the most common Kashmir present in an advanced stage and have worse
tumor (30%), followed by Wilm’s (14%), nervous system outcomes.
tumors, and soft tissue sarcomas (11.8%) each. There was
The distribution of major solid tumors is also different in
an overall male preponderance (M: F 1.9:1), with individual
this region. After CNS tumors, the second most common
tumors being: lymphoma (3.8:1), Wilm’s tumor (5.5:1),
tumor is germ cell tumor followed by PNET/ES, Wilms’
neuroblastoma (2:1), and soft tissue sarcoma (1.2:1).
tumor, osteosarcoma, rhabdomyosarcoma, colorectal
Children below 5 years were more affected (39.8%),
cancer, neuroblastoma, and retinoblastoma. We have
followed by prepubertal children and children
achieved good outcomes in hepatoblastoma, germ cell
between 6 and 9 years of age (29%). Wilm’s tumor and
tumors, osteosarcoma, and Wilms’ tumor. The rest of the
neuroblastoma were more in children below 5 years of age
patients’ had poor outcomes, especially neuroblastoma and
whereas lymphoma and nervous system tumors were more
colorectal cancers.
in children above 5 years of age. The overall incidence of
childhood tumors was 5.4% similar to what was observed Conclusions
in Bombay (now Mumbai) at that time.
This is a pioneering study of the patterns of epidemiology,
Another study was undertaken by Aziz et al. in 1986 to pathology, and outcomes of treatment of pediatric patients
determine the profile of abdominal tumors in pediatric with solid tumors in Jammu and Kashmir. The patients in
population.[24] The profile of 40  patients was studied, with our series are different in that a high percentage presents
majority being in the age group 4–6 years (M:F 28:12). in an advanced stage, a lot of them default and have poor
The ratio of urban to rural background in these children follow‑up. Our study has limitations in that it is a single
was 19:21. Wilm’s tumor accounted for the majority of institution retroprospective study and has not presented
these children, followed by non‑Hodgkin’s lymphoma, and survival data as that would require further prolonged
Neuroblastoma. 93.33% of Wilm’s tumor patients were follow‑up. This is an area of active research in our
operable at the time of diagnosis although some residual institution.
disease was occasionally left after surgery. Only 16.66%
of neuroblastomas were operable the time of diagnosis. Multiple interrelated factors are responsible for the poorer
Surgical debulking was possible only in 41.66% patients of outlook of childhood cancer in India. Limited financial
non‑Hodgkin’s lymphoma. resources, lack of awareness of the meaning of symptoms,
and difficulty in accessing healthcare, abandonment of
A clinical study of primary abdominal tumors in children treatment, and of course, belief in alternative medicines,
revealed that the distribution of various primary abdominal contribute to advanced stage presentation. It is imperative
solid tumors as Wilms tumor 37.5%, Neuroblastoma 15%, to address these issues to improve the outcomes of
Lymphomas 32.5%, Hepatocellular Carcinoma 2.5%, and our patients. This can be done by improving the levels
others (including Teratocarcinoma stomach) 12.5%.[25] of education and public health awareness in the state.
Our data were collected from RCC, SKIMS, Srinagar, over Accessibility to health services, especially in adverse
duration from December 2008 to June 2014 and the overall weather conditions, however, still remains a challenge.
incidence and prevalence of pediatric solid tumors was Furthermore, pediatric patients should be treated in
consistent with data from other national and international dedicated and specialized centers as proved by the excellent
series. The incidence of pediatric cancer including solid results achieved in the USA and Europe, where >90% of
tumors in Jammu and Kashmir has shown a steady increase children are treated in such centers. Finally, advances in
over the years. It is not clear whether this is an actual rise diagnostics including the turn around time and modalities
or an increase in the proportion of patients seeking health of treatments need to be implemented to improve the
care. Among the registered patients, around 5% were of outcomes of our patients.
pediatric age group, and of these, around 30% had solid Financial support and sponsorship
tumors. The most common solid tumors were CNS tumors,
one‑fourth of the patients. Nil.
Some differences have also emerged. The male‑to‑female Conflicts of interest
ratio was lower than that reported in the West and India. There are no conflicts of interest.
The incidence of patients is much higher from rural
areas in Kashmir. Majority of the patients are adolescents References
(12–19 years) as compared to international data where
1. Barr R, Riberio R, Agarwal B, Masera G, Hesseling P, Magrath I.
most of the pediatric patients are in the 0–4 year age group. Pediatric oncology in countries with limited resources. In:
Overall, outcomes were worse than other series. Majority Pizzo PA, Poplack DG, editors. Principles and Practice of
of patients were defaulters (35.64%), only 33.9% patients Pediatric Oncology. 5th ed. Philadelphia: Lippincott Williams and

476 Indian Journal of Medical and Paediatric Oncology | Volume 38 | Issue 4 | October-December 2017
[Downloaded free from http://www.ijmpo.org on Wednesday, January 16, 2019, IP: 202.43.93.18]

Sharma, et al.: Profile of pediatric solid tumors

Wilkins; 2006. p. 1605‑17. Paediatr Oncol 2007;28:33‑5.

2. Ries LA, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, 13. Kusumakumary  P, Jacob  R, Jothirmayi  R, Nair  MK. Profile
et al., editors. Cancer Incidence and Survival among Children of pediatric malignancies: A ten year study. Indian Pediatr
and Adolescents: United States SEER Program 1975-1995, 2000;37:1234‑8.
National Cancer Institute, SEER Program. NIH Pub. No. 99- 14. Summary‑Report on Causes of Death: 2001‑2003 in India.
4649. Bethesda, MD, 1999. Available from: http://www.censusindia.gov.in/Vital_Statistics/
3. Kroll ME, Stiller CA. Time Trends in Incidence 1966-2000. Summary_Report_Death_01_03.pdf. [Last accessed on
Childhood Cancers in Britain: Incidence, Survival, Mortality. 2013 Sep 24].
Oxford Scholarship Online; 2009. 15. Three Year Report of the Population Based Cancer Registries
4. Harif M, Barsaoui S, Benchekroun S, Bouhas R, Doumbé P, 2009‑2011: Report of 25 PBCRs; National Cancer Registry
Khattab M, et al. Treatment of B‑cell lymphoma with LMB Programme, Indian Council Medical Research, Bangalore;
modified protocols in Africa  –  Report of the French‑African 2013. Available from: http://www.ncrpindia.org/Reports/
Pediatric Oncology Group (GFAOP). Pediatr Blood Cancer PBCR_2009_2011.aspx. [Last accessed on 2013 Sep 24].
2008;50:1138‑42. 16. Satyanarayana L, Asthana S, Labani SP. Childhood cancer
5. Howard SC, Pedrosa M, Lins M, Pedrosa A, Pui CH, incidence in India: A review of population‑based cancer
Ribeiro RC, et al. Establishment of a pediatric oncology program registries. Indian Pediatr 2014;51:218‑20.
and outcomes of childhood acute lymphoblastic leukemia in a 17. Kellie SJ, Howard SC. Global child health priorities: What role
resource‑poor area. JAMA 2004;291:2471‑5.
for paediatric oncologists? Eur J Cancer 2008;44:2388‑96.
6. Qaddoumi I, Musharbash A, Elayyan M, Mansour A,
18. Howard SC, Marinoni M, Castillo L, Bonilla M, Tognoni G,
Al‑Hussaini M, Drake J, et al. Closing the survival gap:
Luna‑Fineman S, et al. Improving outcomes for children with
Implementation of medulloblastoma protocols in a low‑income
cancer in low‑income countries in Latin America: A report on the
country through a twinning program. Int J Cancer 2008;122:1203‑6.
recent meetings of the Monza International School of Pediatric
7. Rivera GK, Quintana J, Villarroel M, Santana VM, Hematology/Oncology (MISPHO)‑Part I. Pediatr Blood Cancer
Rodriguez‑Galindo C, Neel MD, et al. Transfer of complex 2007;48:364‑9.
frontline anticancer therapy to a developing country: The
19. Gurney JG, Bondy ML. Epidemiology of childhood cancer.
St. Jude osteosarcoma experience in Chile. Pediatr Blood Cancer
In: Pizzo PA, Poplack DG, editors. Principles and Practice of
2008;50:1143‑6.
Paediatric Oncology. 5th ed. Philadelphia: Lippincott Williams
8. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer
and Wilkins; 2006. p. 2‑14.
statistics, 2009. CA Cancer J Clin 2009;59:225‑49.
20. Arora B, Kurkure P, Parikh P. Childhood cancers: Perspectives in
9. Bleyer A, O’Leary M, Barr R, Ries LA, editors. Cancer
India. J Indian Med Assoc 2005;103:479‑82.
Epidemiology in Older Adolescents and Young Adults 15 to
29 Years of Age, Including SEER Incidence and Survival: 21. Sahu S, Banavali SD, Pai SK, Nair CN, Kurkure PA,
1975‑2000. NIH Publication. No. 06‑5767. Bethesda, Motwani SA, et al. Retinoblastoma: Problems and perspectives
MD: National Cancer Institute; 2006. from India. Pediatr Hematol Oncol 1998;15:501‑8.
10. Crist WM, Anderson JR, Meza JL, Fryer C, Raney RB, 22. Nair R, Pai SK, Saikia TK, Nair CN, Kurkure PA, Gopal R,
Ruymann FB, et al. Intergroup rhabdomyosarcoma study‑IV: et al. Malignant germ cell tumors in childhood. J Surg Oncol
Results for patients with nonmetastatic disease. J Clin Oncol 1994;56:186‑90.
2001;19:3091‑102. 23. Shah A. Pattern of pediatric solid malignant tumors in Kashmir.
11. Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Indian Pediatr 1992;29:1045‑6.
Altekruse SF, et al., editors. SEER Cancer Statistics Review, 24. Aziz AS, Shah AH, Sheikh KA. Clinical profile of abdominal
1975-2011. Bethesda, MD: National Cancer Institute. Based on tumours in children in Kashmir. 1986. Available from: http://
November 2013 SEER Data Submission, Posted to the SEER. medind.nic.in/haa/t02/i1/haat02i1p25g.pdf. [Last accessed on 2014
Available from: http://www.seer.cancer.gov/csr/1975_2011/. [Last Apr 17].
accessed on 2014 Apr 12]. 25. Khan PS, Akhter Z, Majeed S, Wani MY, Hayat H.
12. Rathi AK, Kumar S, Ashu A, Singh K, Bahadur A. Epidemiology Clinicopathological Profile of Childhood Primary Abdominal
of pediatric tumors at a tertiary care centre. Indian J Med Tumours in Kashmir. Indian J Surg 2015;77 Suppl 2:361‑4.

Indian Journal of Medical and Paediatric Oncology | Volume 38 | Issue 4 | October-December 2017 477