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Relapsed Wilms' tumor in pediatric patients: challenges in low- to middle-income countries-a single-center experience
Wael Zekri1, Dalia M Yacoub2, Asmaa Ibrahim3
1Department of Pediatric Oncology, National Cancer Institute, Cairo University, Fom El-khalig Square, Kasr El-Aini St, Cairo, 11796, Egypt. waelzekri@gmail.com.
Insights
Radiotherapy improved survival for children with relapsed Wilms tumor (WT). Patients with stage III WT and positive lymph nodes had the poorest outcomes, highlighting the need for tailored treatment strategies.
Area of Science:
- Pediatric Oncology
- Cancer Relapse Research
- Wilms Tumor Treatment
Background:
- Wilms tumor (WT) is a significant childhood cancer, affecting 1 in 10,000 children.
- While overall survival for WT has improved, outcomes for relapsed cases remain poor, with approximately 50% survival.
- This study focuses on evaluating treatment outcomes for pediatric WT patients experiencing relapse.
Purpose of the Study:
- To assess the survival rates and prognostic factors for pediatric patients with relapsed Wilms tumor.
- To identify specific patient subgroups with poorer prognoses within the relapsed WT population.
- To evaluate the impact of therapeutic interventions, such as radiotherapy, on survival outcomes.
Main Methods:
- Retrospective analysis of 130 pediatric Wilms tumor patients treated at the National Cancer Institute, Egypt (2008-2015).
- Focus on a subgroup of 30 patients (23%) who experienced tumor relapse.
- Univariate analysis was employed to identify prognostic factors for survival post-relapse.
Main Results:
- The 5-year overall survival (OS) and event-free survival (EFS) for relapsed WT patients were 30.9% and 29.8%, respectively.
- Radiotherapy after relapse was significantly associated with improved survival (p=0.012).
- Stage III WT patients with positive lymph nodes demonstrated significantly worse survival (p=0.004).
Conclusions:
- Radiotherapy administration post-relapse is a critical factor in improving survival for pediatric Wilms tumor patients.
- Stage III Wilms tumor with lymph node involvement represents a high-risk group with particularly poor survival outcomes.
- Risk stratification is a significant prognostic indicator in managing relapsed pediatric Wilms tumor.
Background:
Wilms' tumor (WT) affects one in 10,000 children and accounts for 5% of all childhood cancers. Although the overall relapse rate for children with WT has decreased to less than 15 %, the overall survival for patients with recurrent disease remains poor at approximately 50 %. The aim of the study to evaluate the outcome of relapsed Wilms' tumor pediatric patients treated at the National Cancer Institute (NCI), Egypt, between January 2008 and December 2015.
Results:
One hundred thirty (130) patients diagnosed with WT during the study period, thirty (23%) patients had relapsed. The median follow up period was 22.3 months (range 3.6-140 months). The Overall Survival (OS) was 30.9% while the event-free survival (EFS) was 29.8% at a 5-year follow up period. Median time from diagnosis to relapse was 14.4 months. A second complete remission was attained in 18/30 patients (60%). The outcome of the 30 patients; 11 are alive and 19 had died. Three factors in our univariate analysis were prognostically significant for survival after relapse. The first was radiotherapy given after relapse (p = 0.012). The 5-year EFS and OS for the group that received radiotherapy were 41.9% versus 16.7% and 11.1% respectively for those that did not. The second was the state of lymph nodes among patients with local stage III (p = 0.004). Lastly, when risk stratification has been applied retrospectively on our study group, it proved to be statistically significant (p = 0.029).
Conclusion:
Among relapsed pediatric WT, radiotherapy improved survival at the time of relapse and local stage III with positive lymph nodes had the worst survival among other stage III patients.
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