The challenge of nephroblastoma in a developing country

Ekenze, Sebastian O.; Agugua-Obianyo, N.E.N.; Odetunde, OA

doi:10.1093/annonc/mdl167

Cited by 65 publications

(88 citation statements)

References 8 publications

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“…The interval between the end of preoperative chemotherapy and surgery, and between surgery and the start of postoperative therapy was not respected because the surgeon was not available or because the pathology report was not available. This situation, which is unknown or rare in developed countries, has to be compared to those described in other African countries which have, to various degrees, similar socio-economic problems [12,13]. The absence of radiotherapy for selected patients less than 3 years of age, with a small stage III tumor, initially treated by surgery, did not seem to influence the prognosis for this tiny minority [17].…”

Section: Discussionmentioning

confidence: 89%

“…The SIOP studies demonstrated the value of preoperative chemotherapy [3] to limit the risk of tumor rupture during surgery, to increase the percentage of stage I tumors requiring less aggressive treatments and to limit complications associated with surgery [9]. In Africa, the results of such treatment management are fragmentary [10][11][12][13] or are unknown.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of nephroblastoma in Africa: Results of the first French African pediatric oncology group (GFAOP) study

Moreira

Nachef²,

Ziamati

et al. 2011

Pediatric Blood & Cancer

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BackgroundThe multidisciplinary management of nephroblastoma has been defined through multicentric prospective studies and an average 90% of patients cured expected. In Africa, such studies are uncommon and results are fragmentary or unknown in most of the countries. We report the results of the GFAOPNEPHRO 01 study using SIOP 2001 protocol approach.ProcedureFrom April 1, 2001 to March 31, 2004, 8 African Pilot Units were selected to participate in a nonrandomized prospective study. All patients referred with a clinical and radiological diagnosis of nephroblastoma were registered, those aged over 6 months and less than 18 years with a unilateral tumor not previously treated were included in this study and received preoperative chemotherapy. Patients with unfavorable histology or with a tumor other than Wilms tumor, and those with stage IV tumor and persistent disease after surgery were secondarily excluded.ResultsOf the 229 patients initially registered, 166 were included and finally 133 retained in the study, after surgery. Tumor rupture occurred in 7.5% of the patients. Thirty‐five percent were stage I, 22% stage II, 23% stage III, and 18% stage IV. Two‐year disease‐free survival and 5‐year survival are, respectively: 77.9% and 76.7% for localized tumors, 72.7% and 71.6% for all study patients.ConclusionsIt is possible to conduct African multicentric therapeutic studies within the framework of GFAOP. Results in terms of event‐free survival and survival are satisfactory. Improvements with respect to procedure, data collection, and outcome are expected in a new study. Pediatr Blood Cancer 2012; 58: 37–42. © 2011 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Treatment of nephroblastoma in Africa: Results of the first French African pediatric oncology group (GFAOP) study

Moreira

Nachef²,

Ziamati

et al. 2011

Pediatric Blood & Cancer

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“…This assertion can be corroborated by studies done in the sub-Saharan Africa by Ekense et al [2,3] which showed that Wilms' tumour is the most common childhood malignancy in Sub-Saharan Africa. Despite being a malignant tumour, a survival rate of over 90% is now seen today (compared to 30% in the thirties) and this is an evidence of the success of collaborative trials and the use of multimodal therapy [4][5][6].…”

Section: Introductionmentioning

confidence: 61%

“…Most of the tumours weighed between 501-1000 grams representing (40.9%) while 27.3% of the tumour weighed between 1001-1500 grams (Table 1). In terms of tumour volume, majority fell between 1001-2000 cm 3 accounting for (40.9%). Necrosis was observed in 95.5% of the cases.…”

Section: Resultsmentioning

confidence: 99%

Morphological Features of Wilms’ Tumour in a Tertiary Health Care Institution: Our Findings

Soyemi¹,

Osuoji²,

Fa³

et al. 2013

J Clin Exp Pathol

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Nephroblastoma or Wilms' tumour is the most common primary renal malignancy of childhood. Despite being a malignant tumour, a survival rate of over 90% is now seen today (compared to 30% in the thirties) and this resulted from the success of collaborative trials and the use of multimodal therapy. Black children have a 2.5 times increased incidence over their white counterparts and the sex ratio is approximately 1.0. It is also associated with a number of recognised syndromes. The most important prognostic indicators for Wilms' tumour are the histological subtype and the stage at presentation. Although, studies have been carried out on this tumour focussing on the clinical aspect, it is worthy of note that very little study has been done on the morphological features of this tumour in this centre and the country at large. The purpose of this study is therefore to look at the morphological patterns of Wilms' tumour seen in this centre and if possible determine whether a relationship exists between the size, position of the tumour and the histological subtype, and finally, if a particular histological subtype is age-related. Patients and method:This is a retrospective study of the cases of Wilms' tumour seen in the division of paediatric surgery in our tertiary health care institution over a 5-year period i.e. (from Jan 2008 to Dec 2012). The nephrectomy samples of these patients were sent to the department of pathology and forensic medicine in the same institution. During grossing of the samples, adequate attention was paid to any obvious degenerative changes such as haemorrhage and necrosis. Where these changes were seen, they were recorded. The tumour sizes in the largest diameter and weights were also recorded. This was followed by histopathological reports which not only included the diagnosis, but also the histological types. These were all recorded in a pre-designed data form. The age at presentation in months and sex were also recorded in the form. All these were analysed using the statistical package for social science (SPSS) Software version 17.Results: In this study, 44 patients had Wilms' tumour with males representing 26 (59.1%) while females accounted for 18 (40.9%) and a male to female ratio was 1.4:1. The ages of the patients ranged from 10 months to 8 years with mean age value of 4 ± 2.91. The mode as well as the median age was 3 years. 24 (54.5%) of the tumours were located on the left position while 20 (45.5%) were seen on the right side. Most of the tumours weighed between 501-1000 grams representing (40.9%). In terms of tumour volume, majority measured between 1001-2000 cm 3 accounting for (40.9%). Necrosis was observed in 95.5% of the cases. It is also worthy of note that all the tumours had areas of haemorrhage grossly, and 100% exhibiting triphasic histological pattern. This characterizes the classical WT. Bilateral or Synchronous tumour was not seen in this study. Conclusion:The predominant histological pattern of Wilms' tumour in this centre is the triphasic pattern representing th...

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“…It is mainly a childhood cancer, even though it occurs in adults occasionally. In Kenya, Nephroblastoma accounts for 3.3% of childhood cancers [2,3,4,5]. This is a lower incidence than in Western countries where it accounts for up to 8% of childhood cancers [6].…”

Section: Introductionmentioning

confidence: 99%

A Ten Year Retrospective Audit of the Clinic-pathological Management and Treatment Outcomes of Patient’s with Nephroblastoma (Wilms Tumor) at Kenyatta National Hospital

Mwamba¹,

Rogena²,

Kitonyi³

2017

AJCP

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Background and aims: Treatment of Nephroblastoma (Wilms' tumor) in children is one of medicine's success stories. Due to improvements in surgical techniques, drug therapies, and radiation, 85 to 90 percent of children with Wilms tumor who receive state-of-the-art treatment are cured. While this is true for developed countries the outcomes of nephroblastoma (Wilms' tumor, WT) in our hospital and other developing countries are notably below those in these countries. There are continuous reviews and updates of clinical pathologic features, treatment designs, and treatment outcomes every 2 or 3 years, in the developed countries. However, in resource poor countries, such frequent reviews and updates are presently not affordable but, nevertheless, efforts should be made to undertake them every 5 or so years, to improve patient management and treatment outcomes. The objectives of this study were to review the clinical presentation and management of children with Wilms tumor and the factors influencing the outcome at Kenyatta National Referral and Teaching Hospital (KNH). This was a retrospective descriptive cross-sectional study. Analysis of the data was carried out using the statistical package for the social sciences (SPSS) software. The findings of the study will form a basis for revision of treatment design for patients diagnosed with Nephroblastoma at KNH, and by extension, other tertiary public health care facilities in Kenya. Patients and methods: The records of 140 WT patients, aged less than 16 years, who were treated in Kenyatta National Hospital, Kenya, during the period from January 1997 to December 2008 were reviewed. The management protocol followed the scheme of the US National Wilms Tumor Study Group (NSWTG). Results: Thirteen cases (38.2%) were diagnosed as stage I, 4 (11.8%) as stage II, 13 (38.2%) as stage III and 2 (5.9%) as stage IV. Eight cases had bilateral disease (stage V). Four-year overall survival (OS) and event free survival (EFS) rates were xx% and xx%, respectively. Univariate analysis by Log-rank test revealed statistically significant associations between OS and nodal status (p-value < 0.01), manifestation of gross hematuria (p-value 0.02), and tumor size of 10 centimeters or more (p-value 0.02). Multivariate analysis found only the nodal status to be independently associated with OS at a Hazard Ratio of 16.6 (p-value < 0.01). Eight of 13 stage I cases and 6/13 stage III cases had relapsed, with two-year post-relapse survival of 42.8%. Significantly poorer outcome was found in cases with early relapse within 200 days after enrollment (p-value 0.02). Conclusion: Childhood Wilms' tumor presents late in our setting with its consequent management challenges. The need to educate the populace and the primary healthcare providers on the benefits of early diagnosis and treatment of this condition cannot be overemphasized. Large tumor size and gross hematuria were associated with risk of a poorer outcome.

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The challenge of nephroblastoma in a developing country

Cited by 65 publications

References 8 publications

Treatment of nephroblastoma in Africa: Results of the first French African pediatric oncology group (GFAOP) study

Treatment of nephroblastoma in Africa: Results of the first French African pediatric oncology group (GFAOP) study

Morphological Features of Wilms’ Tumour in a Tertiary Health Care Institution: Our Findings

A Ten Year Retrospective Audit of the Clinic-pathological Management and Treatment Outcomes of Patient’s with Nephroblastoma (Wilms Tumor) at Kenyatta National Hospital

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