Five Year Experience of Wilms Tumor at a tertiary care centre, where we stand, a developing country perspective

Abstract

Aim: To analyze demographics and fate of children with Wilm’s tumor (WT) in Pakistan. Settings & duration: In this retrospective study data of all diagnosed patients of Wilm’s tumor presented to the Hematology and Oncology department of the Children’s hospital Lahore during January 2009 and December 2013 was analyzed from record. Methods: Data of all histologically proven cases of WT during the study period was collected from files. Information regarding age, gender, initial staging and outcome was recorded on Performa and analyzed by SPSS. Diagnostic workup included Ultrasound abdomen, CT scan abdomen & chest and USG guided needle biopsy in all patients. All patients were treated according to guidelines of International Society of Pediatric Oncology (SIOP) WT 2001 Protocol. Pre-operative chemotherapy and surgery followed by post-operative chemotherapy according to risk stratification was the prime treatment given to almost all patients. Results: One hundred and seventy five cases were included in the study. Male to female ratio was 1.05.Predominant age group was 2-5 years constituting 50% (88/175) where as above 5 years and below 2 years were almost equal i.e., 44(25%) and 43(24.6%) respectively. Majority of patients presented with advanced disease stage III 36% (62/175) and IV 37(21%) while 26(15%) presented in stage II and only 5% in stage I and V each. Among the patients who received treatment 74/110 (67.2%) got cure of their disease, 20(11.4%) were succumbed while 65(37%) were abandoned with missing record. Ten patients (5%) had relapse disease. Conclusion: Major part of the patients presented with extensive and advanced disease less than five years of age. Treatment result is reasonable with survival rate of 67% without abandonment. Enormous abandonment due to multiple social and financial reasons is a key element in declining overall survival rate that need to be addressed to improve ultimate outcome.