Wilms’ tumour: an 18-year treatment outcome and challenges faced in managing this tumour in developing countries

Abstract

Background: The survival rate of nephroblastoma (Wilms’ tumour) has significantly improved, but the outcome of managing it in developing countries leaves much to be desired, mortality and morbidities still are high.

Objectives: The aim of this study is to review the treatment outcome of nephroblastoma in Nigerian children and to identify factors that play a role in the poor outcome in our setting.

Materials and Methods: This is an 18-year retrospective study of children aged 15 years with Wilms’ Tumour (WT) in two federal tertiary hospitals in northeast Nigeria. Data was obtained from patients’ medical records and the operating registers. Kaplan- Meier test was used to estimate the 2- and 5-year survival rate and the Log Rank analysis employed for the significance of survival rate according to the stage of the tumour.

Results: There were 44 children, 25 (56.8%) boys and 19 (43.2%) girls in a ratio of 1.3:1 with a median age of presentation of 4 years, and only 3 (6.8%) patients presented in less than 2 months of onset of symptoms. Painless abdominal swelling was the most prominent symptom in 35(79.5%) children followed by weight loss in 15(34.1%). All the patients were managed according to the International Society of Paediatric Oncology (SIOP) protocol. Twenty-five patients (25, 60.9%) had a full course of post operative chemotherapy out of whom 11 (44.0%) of them were referred for radiotherapy. Eight (19.1%) patients defaulted post-operative chemotherapy. Twentyone (47.7%) patients died; 14(66.7%) of their tumour, and 7(33.3%) from treatment related complications. Thus the overall survival rate was 52.3% after a median follow up of 24.5 months. Two- and 5-year survival rates were 43.2% (CI 28.5-57.8%) and 11.4% (CI 2.0-20.7%) respectively.

Conclusion: Our study revealed poor treatment outcome from WT, probably because of associated late presentation and incomplete treatment.