Outcomes of Wilms tumor treatment in western Kenya

Aniek Uittenboogaard, Festus Njuguna, Saskia Mostert, Sandra Langat, Mirjam E. van de Velde, Gilbert Olbara, Terry A. Vik, Gertjan J. L. Kaspers

Research output: Contribution to journalReview articleAcademicpeer-review

6 Citations (Scopus)

Abstract

Background/objectives: Wilms tumor (WT) is a curable type of cancer with 5-year survival rates of over 90% in high-income countries, whereas this is less than 50% in low- and middle-income countries. We assessed treatment outcomes of children with WT treated at a large Kenyan teaching and referral hospital. Design/methods: We conducted a retrospective record review of children diagnosed with WT between 2013 and 2016. Treatment protocol consisted of 6 weeks of preoperative chemotherapy and surgery, and 4–18 weeks of postoperative chemotherapy depending on disease stage. Probability of event-free survival (pEFS) and overall survival (pOS) was assessed using Kaplan–Meier method with Cox regression analysis. Competing events were analyzed with cumulative incidences and Fine–Gray regression analysis. Results: Of the 92 diagnosed patients, 69% presented with high-stage disease. Two-year observed EFS and OS were, respectively, 43.5% and 67%. Twenty-seven percent of children died, 19% abandoned treatment, and 11% suffered from progressive or relapsed disease. Patients who were diagnosed in 2015–2016 compared to 2013–2014 showed higher pEFS. They less often had progressive or relapsed disease (p =.015) and borderline significant less often abandonment of treatment (p =.09). Twenty-nine children received radiotherapy, and 2-year pEFS in this group was 86%. Conclusion: Outcome of children with WT improved over the years despite advanced stage at presentation. Survival probabilities of patients receiving comprehensive therapy including radiation are approaching those of patients in high-income countries. Additional improvement could be achieved by ensuring that patients receive all required treatment and working on earlier diagnosis strategies.
Original languageEnglish
Article numbere29503
JournalPediatric Blood and Cancer
Volume69
Issue number4
Early online date2021
DOIs
Publication statusPublished - 1 Apr 2022

Keywords

  • Wilms tumor
  • chemotherapy
  • outcomes research
  • pediatric oncology
  • sub-Saharan Africa
  • surgery

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