BACKGROUND AND AIMS:Wilms tumour (WT) has excellent event-free and overall survival (OS). However, small differences exist between countries participating in the same international study. This led us to examine variation in adherence to protocol recommendations as a potential contributing factor. METHODS:Retrospective analysis of risk-stratified chemotherapy and radiotherapy regimens given to children with unilateral WT treated with pre-operative chemotherapy in the SIOPWT2001 (2002-2011) and Improving Population Outcomes for Renal Tumours of Childhood (IMPORT) (2012-2018) studies in the United Kingdom and Ireland. Pre- and post-operative treatments were classified as per protocol (PP), deviation (PDEV)-variation for specified clinical reasons, violation (PVIOL)-not treated PP. RESULTS:A total of 1256 children with WT were registered by 20 centres. A total of 1052 (84%) had unilateral WT treated with pre-operative chemotherapy. All had centrally reviewed pathology. Case report forms allowing categorisation of the whole treatment pathway were available for 756 (72%) patients. Treatment was classified as PP in 452 (60%), PDEV in 175 (23%) and PVIOL in 129 (17%). Stage III/IV tumours had higher proportion PVIOL (21% and 35%, respectively) compared to Stage I/II tumours (8%-10%). Two-thirds of patients were treated in 'high-volume' centres (≥5 new WTs/year). Protocol adherence rates were similar between high- and low-volume centres. Protocol adherence category had no impact on event-free or OS. CONCLUSIONS:Protocol guidelines are followed closely for lower stage tumours, but there is greater variation in advanced disease. Centre size showed no association with survival, emphasising the effectiveness of using a national treatment protocol, supported by central pathology review.

BACKGROUND:The Paediatric Oncology Centres (POCs) treating childhood cancer in South East England produce unified supportive care guidelines for use in the secondary pediatric (shared care) units. This study evaluated the adherence to current guidelines for febrile neutropenia (FN) and documented outcome in terms of bacterial isolates, antibiotic resistance patterns, length of hospital stay, and mortality.PROCEDURE:Prospective study of pediatric FN admissions between July 2001 and December 2002.RESULTS:Data were received on 433 eligible FN episodes in 212 patients. The recommended empirical antibiotics (piptazobactam + gentamicin) were used in 354 (82%) admissions. Blood cultures were positive in 129 episodes (30%). Gram-positive organisms predominated (120/149 organisms isolated) and the majority were coagulase-negative Staphylococci (95/120). There were 27 Gram-negative isolates and 1 fungal isolate. No Gram-negative isolate was resistant to both first-line antibiotics. Only one death was recorded in the study group. The median length of hospital stay was 5 days.CONCLUSIONS:We obtained data on a large number of shared care episodes of FN. The antibiotic guidelines were followed in most episodes. Bacteremia was common, but little resistance to first-line antibiotics was documented among Gram-negative isolates, confirming the safety of the strategy in our population.