Management and Outcomes of Patients Treated for Wilms’ Tumor at Kenyatta National Hospital

Abstract

Background Wilms’ Tumour also known as Nephroblastoma, is a highly curable renal malignancy of childhood and is considered one of the success stories in modern medicine with excellent 5-year survival rates of greater than 90%. Management of Wilms Tumour is a paradigm of successful interdisciplinary approach and uses multimodal treatments. Various treatment protocols have been put in place to guide in the management of patients with Wilms’ Tumour. The two most common protocols in use worldwide are NWTSG/COG and SIOP; NWTSG/COG recommends upfront surgery whereas SIOP recommends pre-operative chemotherapy. Nevertheless, it continues to produce dismal survival rates in the developing countries. Some of the factors contributing to these outcomes include: late presentations, abandonment of treatment, lack of medical personnel, lack of funds and lack of medical infrastructure. Over time, our health care has greatly improved. We now have better healthcare systems in terms of better imaging and diagnostics, better surgical skills, better access to healthcare and better awareness among health care workers. This study therefore aims to assess the current outcomes of patients managed for Wilms’ Tumor post the improvement in the healthcare systems. Broad Objective This study intends to evaluate the management and outcomes of patients treated for Wilms’ Tumour at the Kenyatta National Hospital. Study design and site This was a retrospective cross-sectional study of patients with Wilms’ Tumour diagnosed and treated between 1st January 2015 to 31st December 2019 at Kenyatta National Hospital. Materials and Methods Files of patients managed for Wilms’ tumour between 1st January 2015 to 31st December 2019 were obtained from the records department. A data abstraction tool was used to extract information. Data collected included: socio-demographic characteristics, disease stage, histology type, imaging modality used in staging of disease, treatment modality/modalities utilized in the management, treatment protocol used for treatment (NWTSG/COG versus SIOP) and the outcome at 2 years post treatment. Data management Data analysis was performed using STATA 11.0. Socio-demographics was analysed using medians and frequency distributions (percentages). Clinical characteristics such as stage and presenting symptoms were described using frequency distributions and were presented in form of pie- charts. Patients with an absolute indication of radiotherapy to the flank were described as a proportion of the number that actually received the radiotherapy to the total number of those who required radiotherapy. The 2- year overall survival was estimated using Kaplan-Meier which is a non- parametric test. Expected main outcome The expected outcome of this study was that the outcomes of patients managed for Wilms’ Tumour will have improved post the improvement of the healthcare systems in the developing nations