Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study.

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined. METHODS: This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach. DISCUSSION: This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research. TRIAL REGISTRATION: This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021,  NCT05177393 .

Limb Salvage Surgery in Osteosarcoma of the Femur Using Liquid-Nitrogen-Frozen Free Femur Autograft in a Developing Country.

Introduction: Limb salvage is a technically demanding and capital intensive procedure. In low-income countries, amputation followed by prosthesis use is widely used for the treatment of limb malignancies. This is associated with considerable morbidity and frequent non-adherence to prosthetic use. Therefore, we are reporting a case of osteosarcoma of the femur treated by the use of pre-operative chemotherapy, followed by frozen free femur autograft and intramedullary nailing, with excellent radiologic and functional results at 1 year of follow-up, in a developing country. Case Report: A 16-year-old female presented with the left thigh swelling and pain for 3 months. X-ray of the left femur showed an osteosclerotic tumor in the medial aspect of the middle third of the left femur, diagnosed as osteogenic sarcoma on biopsy. Pre-operative chemotherapy was given. En bloc resection of the tumor was done. The cleaned femur shaft was frozen in liquid nitrogen, reimplanted, and stabilized with an intramedullary nail. One year after surgery, the femur osteotomy sites are fully united and the patient is fully ambulant, without evidence of metastasis or recurrence. Conclusion: This case describes the successful use of a free frozen autograft of the femur in a 16-year-old girl with osteosarcoma of the left femur, done in a developing country, Kenya. It demonstrates the feasibility of limb salvage using this technique in low-income countries.