Pattern, clinical presentation and management of wilms' tumor in Moshi, Tanzania

The aim of this study was to audit the treatment outcome of children with Wilms' tumor in East Africa, at a Urology referral center with limited access to imaging modalities and chemotherapeutic drugs, and no radiation facility. This is a retrospective analysis of the hospital records of children with a diagnosis of Wilm's tumor treated from June 1996 to May 2005 at the Association of Surgeons of East Africa [ASEA] Institute of Urology, Kilimanjaro Christian Medical Centre [KCMC], Moshi, Tanzania. In total, 50 patients were diagnosed with Wilms' tumor in the 9 years study period, but only 39 files contained sufficient information for analysis. The average age at presentation was 44.7 months [median 36, range 8 to 120 months]. 25.6% of the children were >60 months old. The male:female ratio was 1.4:1. All of the children presented with an abdominal mass detected by the parents. The hemoglobin was < 100gm/L in 21 [53.8%] and the platelet count was >450,000/ml in 8 [20.5%] cases. Ultrasound imaging was obtained in all cases, but CT imaging was not taken. Intravenous urography was done in 38 children and showed non-visualization of the involved kidney in 16 [42.1%]. Fine needle aspiration cytology [FNAC] was performed in 25 cases and was diagnostic in 23 [92%]. Preoperative vincristine and dactinomycin was given to 23 patients [59%] with marked tumor shrinkage in 20 [87%], while 3 [13%] showed no response. Radical nephrectomy was performed in all patients, and 3 patients [7.7%] died within 24 hours of surgery. Pathologic analysis showed favorable histology in 35 [89.7%] and unfavorable histology in 4 [10.3%] patients. Based on the pre- and intra-operative findings. NWTS stage 1,2,3,4 and 5 was present in 25.6%, 17.9%, 15.4%, 38.5% and 2.6%, respectively. Postoperative dactinomycin and vincristine was given monthly for one year in all patients, while doxorubicin and cyclophospamide were reserved for those with no response to the first-line drugs, or recurrent tumor. Radiotherapy was not available. At 12 months' follow-up the overall disease-free survival was 35.9%, recurrence had occurred in 38.6%, death in 15.4%, and 10.3% were lost to follow-up. Children with Wilms' tumor in East Africa still have a dismal prognosis, with treatment outcomes at levels where it was before the advent of chemotherapy and radiation therapy in more advanced centers