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Improved survival of children with wilms tumor
Tezer Kutluk1, Ali Varan, Nebil Büyükpamukçu
1Department of Pediatric Oncology, Hacettepe University Institute of Oncology, Hacettepe University, Faculty of Medicine, 06100 Ankara, Turkey. tkutluk@tr.net
Insights
Survival rates for pediatric Wilms tumor patients significantly improved over three decades due to evolving treatment strategies. This study highlights advancements in pediatric oncology, showing better outcomes with modern chemotherapy regimens and earlier disease detection.
Area of Science:
- Pediatric Oncology
- Cancer Survival Rates
- Wilms Tumor Treatment
Background:
- Wilms tumor is a common pediatric kidney cancer.
- Treatment strategies and survival rates have evolved over time.
- Single-institute studies are crucial for tracking long-term outcomes.
Purpose of the Study:
- To analyze changes in the overall survival (OS) rate of children with Wilms tumor.
- To evaluate the impact of treatment regimens, disease stage, and histopathology on survival.
- To assess the evolution of pediatric oncology in Turkey from 1972 to 1999.
Main Methods:
- Retrospective analysis of 327 children diagnosed with Wilms tumor between 1972 and 1999.
- Survival rates analyzed based on disease stage, histopathology, and treatment protocols.
- Comparison of 10-year OS rates across different treatment periods and chemotherapy regimens.
Main Results:
- The overall 10-year OS rate was 60.6%, improving from 48.5% (1972-1979) to 72.8% (1990-1999).
- Improved survival observed with combination chemotherapy (actinomycin-D + vincristine) and intensified regimens for advanced stages.
- Significant increases in 10-year OS for stages III and IV disease, from 46.4% to 75% and 13.4% to 54.5% respectively.
Conclusions:
- Pediatric Wilms tumor survival rates have markedly improved due to advancements in treatment strategies.
- Treatment evolution in Turkey parallels progress seen in Western pediatric oncology centers.
- Continued research and protocol refinement are essential for further enhancing pediatric cancer outcomes.
Abstract:
To analyze changes in the overall survival (OS) rate of children with Wilms tumor treated in a single institute over nearly 30 years. This study included 327 children with a newly diagnosed Wilms tumor. Their median age was 3 years, and the male:female ratio was 1.1. Survival rates were analyzed according to the stage of disease, histopathology, and different treatment regimens used between 1972 and 1999. At diagnosis, 51.1% of patients had advanced stage disease. Ten patients had anaplasia, and; 97% (317 patients) of the tumors had favorable histopathology. The 10-year OS rate was 60.6% for the entire group, but varied according to the years in which the patients were treated, the chemotherapy regimen, and stage of disease. Patients treated during the periods of 1972 to 1979, 1980 to 1989, and 1990 to 1999 had 10-year OS rates of 48.5%, 64.3%, and 72.8%, respectively. The 10-year OS rate in children treated with actinomycin only was 36.7% compared with 48% for children treated with the actinomycin-D+vincristine regimen with a 3-month interval, 67% for the actinomycin-D+vincristine regimen with a 1.5-month interval, 54.5% for the poor-risk regimen (actinomycin-D, vincristine, cyclophosphamide, and adriamycin), and 53.4% for the SIOP-9 protocol. Children with stage I to IV disease had 10-year OS rates of 75%, 77.1%, 54.4%, and 30.4%, respectively. The 10-year OS rates for children with stage III and IV disease increased from 46.4% and 13.4% for patients treated between 1972 to 1979 period to 75% and 54.5% for children treated during 1990 to 1999. The 10-year OS rate for children with Wilms tumor improved as treatment strategies evolved, illustrating that pediatric oncology in Turkey is developing parallel to the Western world.
