CLINICAL EXPERIENCE IN THE MANAGEMENT OF PEDIATRIC WILMS TUMOR

Abstract

Wilms tumor is the commonest renal tumor in children. This study aimed to evaluate the characteristics, diagnosis, treatment, and outcome of Wilms tumor in pediatric age group and to analyze factors affecting the outcome. This retrospective study included 61 children younger than 15 years with Wilms tumor who were managed at Basrah Children Specialty Hospital during the period between 2011 and 2016. Patients` characteristics, mode of diagnosis, treatment modalities, complications, relapse, and outcome were all reviewed. The results showed that Wilms tumor was the commonest tumor affecting the kidneys (85%). The median age of onset was 30 months, and mostly in children aged 2-4 years. The most common presenting feature was abdominal mass (44.3%). Twenty three patients were diagnosed as stage 1 (37.7%). Favorable histology Wilms tumor was encountered in only 65.6%. Tumor relapse was seen in 12 patients (19.7%), eight of them died (66.7%). The overall 2-year survival was 70.5% (43 cases). In conclusion, Wilms tumor is the most common renal tumor with high rate of unfavorable histology (anaplasia) in our society. Stage I tumor is the predominant stage but unfortunately carries a relatively high mortality. Advanced stages still represent a significant proportion which may reflect poor awareness and delayed diagnosis which thereafter worsens the outcome. Advanced stages, presence of anaplasia, and tumor relapse are the major factors affecting survival of children with Wilms tumor.