Wilms tumor treatment outcomes: perspectives from a low-income setting

Abstract

Wilms tumor is the most common primary renal malignancy in children. It accounts for 5% of childhood malignancies.1 It is thought to arise from nephrogenic rests, which are foci of persis tent metanephrenic cells.2 Survival rates have improved from 20% in the 1960s to approximately 90% currently in high-income countries; middle income countries have survival rates of approxi mately 80%.2,3 This has been achieved through cooperative study groups as well as use of multi modal approaches to therapy. The two main study groups that have been involved are the National Wilms’ Tumor Study Group and the International Society of Pediatric Oncology (SIOP).2,4,5 Low-income countries, however, have survival rates between 20% and 50%.1-3 Reasons for the low survival in low-income countries include lim ited access to proper medical care as a result of lack of facilities for treatment, shortage of person nel, long distances to treatment centers, poor infrastructure, and limited public transport facili ties. These factors lead to late presentation, which also affects outcomes. Other contributors to the low survival include lack of health insurance, abandonment of treatment, and lack of a multi disciplinary approach to the management of patients. Treatment includes surgery and che motherapy, as well as radiotherapy for metastatic disease.2,3,5 The aims of our study were to assess the treatment outcomes of children presenting with Wilms tumor at a Kenyan academic hospital and to evaluate the influence of various socio demographic and clini cal characteristics (eg, age at diagnosis, sex, du ration of symptoms, stage of disease, distance to hospital, and health insurance status) on treatment outcome