Wilms' tumor : The experience of the pediatric unit of kasr el-aini center of radiation oncology and nuclear medicine (nemrock)‎

Abstract EN

Aim of the Work : The aim of the present work is to study the treatment results of Wilms’ tumor patients who had attended the pediatric unit of Kasr El-Aini center of radiation oncology and nuclear Medicine (NEMROCK) from January 1994 to January 2001.

Patients and Methods : Sixty-two new Wilms’ tumor patients attended the clinic (NEMROCK) from January 1994 until January 2001.

The diagnosis was confirmed pathologically.

Stage I included 22 cases, stage II 17 cases, stage III 16 cases, and stage IV included 4 cases, whereas stage V included only 3 cases.

Stage I cases received 6 months of vincristine and dactinomycin.

Stage II with favorable histology (FH) received 1 year of vincristine and dactinomycin.

Stage III and IV received 1 year of vincristine, dactinomycin and doxorubicin.

Abdominal radiation therapy, 1080cGY, was given in case of tumor spillage during surgery either to the involved flank or the whole abdomen depending on whether contamination was limited to the flank only or the whole abdomen.

In addition, radiation was given to metastatic sites in stage IV.

Stages II, III, IV with unfavorable histology (UH) received 1 year of dactinomycin, vincristine, doxorubicin and cyclophosphamide in addition to radiation therapy.

Stage V cases were diagnosed by surgical biopsy and were managed according to stage and pathology.

Results : Forty patients (64.5 %) had favorable histology while twenty-two patients (35.5 %) had unfavorable histology.

The 4-year overall survival rate was 70.1 %.

Stage I, II, and stages III + IV + V with favorable histology had a 4-year overall survival of 82.3 %, 56 % and 41 %, respectively.

Stages I to IV with unfavorable histology had a 4- year survival of 65.7 %.

Conclusion : Multivariate analysis revealed that stage and residual disease after surgery significantly affected overall survival ; while histopathology and stage affected significantly disease-free survival.

Moreover, our study revealed that residual disease after surgery affected sig- nificantly the incidence of local recurrence and distant metastases.