Management and outcome of patients with Wilms’ tumour (nephroblastoma) at the Moi teaching and Referral Hospital, eldoretKenya

Abstract

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 treatment with 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.