Survival of children with a Wilms tumor in Blantyre, Malawi

Area of Science:

• Pediatric Oncology
• Global Health

Background:

• Wilms tumor (WT) survival exceeds 90% in high-income nations, contrasting sharply with lower rates in sub-Saharan Africa.
• Long-term outcomes for WT in sub-Saharan Africa are poorly understood due to follow-up challenges.

Purpose of the Study:

• To evaluate the outcomes of an adapted Wilms tumor treatment guideline implemented in Blantyre, Malawi.
• To assess event-free survival and identify causes of treatment failure in children with WT.

Main Methods:

• An adapted WT treatment guideline, including preoperative chemotherapy and enhanced supportive care, was introduced in 2006.
• 73 children with unilateral WT were treated between 2006-2011 with a focus on consistent follow-up, including home visits.
• Median follow-up was 5 years, with event-free survival assessed at 2 and 5 years.

Main Results:

• Two and five-year event-free survival rates were 46% and 42%, respectively.
• Treatment failures included 7% abandonment, 15% death during treatment, and 30% disease-related deaths (persistent disease/relapse).

Conclusions:

• The adapted WT treatment guideline showed limited initial success in improving survival rates in Malawi.
• Challenges in long-term follow-up hinder accurate assessment of pediatric cancer outcomes and intervention effectiveness.
• Strategies to improve treatment completion and long-term monitoring are essential for enhancing Wilms tumor care in low-resource settings.