Wilms' tumour: the value of post-operative treatment in decreasing relapse rate

ABSTRACT

A retrospective clinico-epidemiologicalstudyand evaluation of therapeutic modalities in patients suffering from Wilm's tumour has been carried out at Kasr El-Aini center of radiation oncology and nuclear medicine[NEMROCK] during the period 1971-1985 inclusive. Eighty-four cases had a histological confirmation of their disease. Wilms'tumour represented 6.6% of all cancer in children below 15 years old. The mean age was 47.8 +/- 41.2 months. It was 40. 2 +/- 20.3 years for males and 56.7 +/- 55.5 years for females. The male to female ratio was1.21. Clinical stages I and II constituted 32.1% of the case while stage III represented 30.9% and "Unstaged" group [inadequate date for staging] represented 29.8%. Eight cases[9.5] were reported histologically unfavourable, one had a clear cell and seven had diffuse anaplasia. Cases associated withbonemetastasis [Unfavourable behaviour] were only considered of unfavourable histology if histologically confirmed. In 43 evaluable patients a better prognosis was seen in early clinical sages [14 cases with stage I and II] than the remaining cases [29 cases]. A statistically significant low relapse rate of42.8% [12/28 cases] was observed in cases who received post- operative therapy [both radiotherapy and chemotherapy] than cases who did not receive such treatment [100%, 7/7 cases]. In cases who started therapy within 10 days after the operation no relapse occurred, while those who started therapy after 10 days the relapse rate was 64.1% [25/39 cases]. A statistically significant lower abdominal relapse rate [6.1%,2/33 cases] was observed following abdominal irradiation than in cases who did not receive such irradiation [60.0%, 6/10 cases]. Four out of eight cases with pulmonary metastasis [50.0%] achieved complete response after combination chemotherapy [2 relapsed with a median duration of 4.5 months and 2 still free of disease with a disease free survival of 17 and 21 months]