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MANAGEMENT AND OUTCOME OF PATIENTS WITH WILMS' TUMOUR (NEPHROBLASTOMA) AT THE MOI TEACHING AND REFERRAL HOSPITAL,
C N Tenge1, P A Were, L H Aluoch
1Department of Child Health and Paediarics, Moi University, School of Medicine, Eldoret, Kenya.
Insights
This study on pediatric Wilms tumor in Kenya found that while combined treatment improved survival, challenges like incomplete staging and patient follow-up impacted outcomes. Improving these areas is crucial for better pediatric cancer care.
Area of Science:
- Pediatric Oncology
- Nephrology
- Cancer Research
Background:
- Wilms' tumour is a common pediatric kidney cancer in Kenya.
- It shows good response to combined treatment, even in resource-limited settings.
Purpose of the Study:
- To evaluate the management and outcomes of Wilms' tumour patients.
- Study conducted at Moi Teaching and Referral Hospital (MTRH) from 2000-2007.
Main Methods:
- Retrospective study design.
- Analysis of 45 Wilms' tumour patient records.
- Data collected from MTRH's Paediatric Oncology Service.
Main Results:
- Most patients (93%) were referred; 76% were under 48 months old.
- Abdominal ultrasound was universal, but staging was incomplete.
- 41 patients received treatment, 28 with combined modality; 42% were lost to follow-up.
- 29% of patients survived beyond three years.
Conclusions:
- Wilms' tumour staging was inadequate.
- Neoadjuvant chemotherapy reduced morbidity and mortality.
- Loss to follow-up and treatment costs negatively impacted outcomes.
Background:
Wilms' tumour is a common malignant neoplasm of the kidney and is ranked among the top six solid tumours in children in Kenya. Despite its rapid growth and therefore debilitating effects on its victims, it is one tumour that has shown good response to combined modality approach to its treatmentwith encouraging possibilities of survival even in resource poor settings.
Objective:
To evaluate the management and outcome of patients with Wilms'tumour attended to at Moi Teaching and Referral Hospital (MTRH) during the period between January 2000 and December 2007.
Design:
Retrospective Study.
Setting:
The Paediatric Oncology Service (Oncology unit in the Paediatric Ward, the Paediatric Surgical Ward and the Outpatient Oncology Clinic) at the Moi Teaching and Referral Hospital, Eldoret, Kenya.
Results:
Information of 45 patients diagnosed with Wilms' tumour was analysed. Forty two (93%) of the patients were referrals from various health facilities in the region. Twenty three (51%) were male and 34 (76%) were aged less than 48 months. Twenty five (56%) had the left kidney affected, 19 (42%) the right kidney and one (2%) bilateral. All the 45 (100%) had an abdominal ultrasound done but none had exhaustive investigations done to stage the disease. Only eight (18%) of the patients had a medical insurance cover. Fourty one (91%) of the patients received specific cancer treatment with 28 (62%) getting combined modality treatment. Nineteen (42%) were lost to follow up. Thirty (67%), 21 (47%), 15 (33%) and 13 (29%) patients were alive six months, one year, two years and three years respectively from the time of diagnosis. 29% survived beyond three years of diagnosis.
Conclusion:
Staging of Wilms tumour fell short of the expected. Neo-adjuvant chemotherapy reduced morbidity and mortality of patients managed for Wilms' tumour. Loss to follow up and cost of treatment had a negative impact on the outcome, a situation that requires to be improved.