Surgical control has prognostic value in neuroblastoma (NB). Advanced NB is common at diagnosis in South Africa. We investigated the pre-surgery factors that influenced decisions to perform surgical resections. We included 204 patients with high-risk NB from a national retrospective study, who completed induction chemotherapy between 2000 and 2016. The median age was 32.4 months (IQR 15.1 − 53.5 months). Primary tumor resection was achieved in 76.9% of patients between 0-18 months of age, 51.8% between 18-60 months and 51.7% older than 60 months (p < 0.001). Only 43.2% of patients with distant metastatic disease had surgery done (p < 0.001). LDH was >750 U/L in 46.8% and ferritin >120 g/dL in 53.1% of those who had surgery (p = 0.005). The majority (80.4%), who had achieved post-induction metastatic complete remission (mCR), were operated, while 28.7% without mCR had surgery (p < 0.001). The long-term overall survival in patients with mCR and primary tumor resection was 36.5% compared to those with mCR without primary tumor resection (25.4%) and without mCR (≤3.0%)(p < 0.001). Age (p < 0.001), stage (p < 0.001), mCR (p < 0.001) and treatment setting (p < 0.001) were of prognostic significance. The tumor site and MYCN-amplification did not significantly predict resection rates. Post-induction mCR and stage were associated with surgical resection and five-year OS (p < 0.001) on multivariate analysis. Patients with high-risk NB who achieved mCR and had primary tumor resections are curable in limited resourced settings. Stage and post-induction mCR were significant variables that led to surgery. These variables should be included as indications in the management of metastatic NB in resource limited settings.

The South African Journal of Oncology is a peer-reviewed on-line journal which publishes high quality articles on all aspects of oncology. The Editorial Board strongly supports a multidisciplinary approach to cancer care research as well as translational research in oncology.

Background and Objectives: Existing literature on ovarian masses necessitating intervention in children by pediatric surgeons and gynecologists in Low‐ and Middle‐Income Countries is sparse and lacks collaborative standardization in management between the two subspecialties. Therefore, this study seeks to assess the range of ovarian masses presenting to these two specialties and to explore variations in management. Methods: A 15‐year retrospective review of surgically biopsied or excised ovarian masses between subspecialties at two academic hospitals in Johannesburg. Results: We identified 288 patients, six with bilateral disease and 294 ovarian masses. The mean age was 13.34 years (SD ±5.12). The most common presentation was abdominal pain in 149/288 (51.74%); 117 patients (40.62%) were from pediatric surgery and 171 (59.38%) from gynecology departments. There were 127/288 (44.09%) non‐neoplastic and 161/288 (55.90%) neoplastic lesions, of which 110/161 (68.33%) were benign and 51/161 (31.67%) malignant. The neoplastic lesions consisted of 107/161 (66.45%) germ cells, 28/161 (17.39%) surface epithelial tumors, and 26/161 (16.14%) sex cord‐stromal tumors. Ovarian‐sparing surgery was done in 56/288 (19.44%) patients, 22/117 (18.80%) in pediatric surgery, and 34/171 (19.88%) in gynecology. Laparoscopy was done in 57/288 (19.79%) patients, 24/117 (20.51%) in pediatric surgery, and 19/171 (19.29%) in gynecology. The survival rate in benign masses was 100%, and 86.28% in malignancies. Conclusion: This study highlights the diverse spectrum of ovarian masses managed by pediatric surgeons and gynecologists. A laparoscopic approach combined with ovarian preservation, which was comparable between specialties, should be the preferred method for managing benign lesions whenever feasible. These findings underscore the need for standardized, collaborative guidelines between pediatric surgeons and gynecologists to ensure consistent and optimal management of ovarian masses in children.

Background: In lowto middle-income countries (LMICs) like South Africa, there is a need to understand the clinical practices surrounding diagnosis and surveillance of paediatric Hodgkin lymphoma (HL) to reduce the burden on health systems. Understanding the clinical utility of PET/CT scans may decrease repeated tissue biopsies during disease surveillance.Methods: This is a retrospective cohort study of patients aged less than 18 years treated for HL at Chris Hani Baragwanath Academic Hospital from 1 January 2009 to 31 December 2018.Results: Fifty-four patients were included in the study; male-to-female ratio was 5:1 with a mean age of 9 years. Seventy per cent of patients (n = 38) received a PET/CT and tissue biopsy during their initial diagnostic workup, whereas 20.4% (n = 11) of patients received a PET/CT and tissue biopsy during surveillance. Tissue biopsy and PET/CT showed slight agreement (kappa = 0.14) in diagnosing relapsed disease during surveillance. The false negative rate for tissue biopsy during surveillance was 42.9%. Surveillance PET/CT showed a positive predictive value (PPV) of 66.7% and negative predictive value (NPV) of 100% when compared to tissue biopsy.Conclusion: This study is the first cohort to explore the clinical utility of PET/CT scans and tissue biopsies in a lowresourced setting. Our findings showed slight agreement between the modalities in diagnosing relapsed disease during surveillance. A portion of this discordance can be attributed to false negative tissue biopsy results. While the sample is limited, our findings are consistent with the high NPV of PET/CT scans of > 95% as is reported in the literature.