FCCT Blog Post #23

By Randy Hurley MD, cTropMed

Retired, HealthPartners and Regions Hospital Cancer Care Centers

University of Minnesota, Global Health Faculty

FCCT Blog post #23

August 19th, 2026

KCMC-FCCT Tumor Board

Two cases were discussed at the August 2026 tumor board

A 7-year-old boy with metastatic Wilm’s tumor was discussed again at tumor board to review the radiation therapy plan.  He had undergone a nephrectomy at an outside institution and was referred to KCMC.  Upon, restaging, he had CT evidence of recurrence in the nephrectomy bed with lung, liver and para-aortic metastases.  He had an inadequate response to multiagent neoadjuvant chemotherapy but responded well to two cycles of ICE (ifosfamide, carboplatin and etoposide) salvage chemotherapy. The plan was for whole abdominal and whole lung radiation therapy followed by additional adjuvant chemotherapy.  Wilm’s tumor in the USA is primarily a pediatric cancer that is most common in African American children.  In Tanzania, -0Wilm’s Tumor is the 2nd most common pediatric cancer and often does not respond adequately to neoadjuvant chemotherapy. (https://link.springer.com/article/10.1186/s43054-025-00432-0) (https://www.sciencedirect.com/science/article/pii/S2468124526000343)

The second case involved a 29 year-old woman with locally advanced (T2-3N3M0) non-keratinizing nasopharyngeal carcinoma (NPC) who had a suboptimal response to induction chemotherapy.  She had presented with a 2-year history of left neck swelling that progressed to bilateral neck swelling.  CT imaging of the neck, chest, abdomen and pelvis identified a nasopharyngeal mass without osseous or intracranial extension. There was extensive bilateral cervical (8cm in size), supraclavicular and infraclavicular adenopathy without evidence of distant or bone metastases. Biopsies of the nasopharyngeal mass and a cervical lymph node were compatible with non-keratinizing NPC.  Immunohistochemistry with cytokeratins (AE1/AE3) to confirm NPC and CD45 (to rule out a hematologic malignancy) were not available.  In the USA, additional pathologic testing may have included Ebstein-Barr virus in-situ hybridization and/or blood EBV DNA testing, PDL1 testing and perhaps testing for HPV.  Additional local and systemic imaging is often performed in the USA including MRI of the skull base to evaluate the extent of the primary tumor and either PET CT or bone scan to evaluate more thoroughly for distant metastases. She had an initial response to a first cycle of carboplatin and paclitaxel but had progression with the second and third cycle.  A consideration was being given for concomitant chemotherapy with radiation. In the USA, cisplatin and gemcitabine, the most commonly used neoadjuvant regimen for NPC, is associated with 90% response rates; addition of immunotherapy is reserved for resistant disease. The discussion revolved around how certain the diagnosis was, if an aggressive lymphoma was still in the differential diagnosis and whether delay in treatment to re-biopsy was feasible.  Mremi, et al have reported the role of minimal immunohistochemical stains in differentiating NPC in Tanzania (https://www.ovid.com/jnls/nimj/fulltext/10.4103/nmj.nmj_134_19~the-role-of-a-minimum-immunohistochemical-antibody-panel-in ).  There was concern regarding how well she could tolerate 7000 cGy of extend-field bilateral neck radiation for NPC.  Several considerations were discussed including a plan for re-biopsy while moving forward with treatment pending the results.  Cisplatin and gemcitabine have activity in nasopharyngeal carcinoma and non-hodgkins lymphoma and perhaps could be a bridging therapy awaiting pathology results.  Overall, head and neck cancer is the 6th most common cancer in Tanzania although NPC remains rare.  KCMC has reported the increasing incidence of head and neck cancers in northern Tanzania  ( https://www.kcri.ac.tz/head-and-neck-cancer-trends-and-geographical-distribution-head-and-neck-cancer-tertiary-hospital )