%0 Journal Article
%T Pattern, clincal presentation and management of Wilms' Tumor in Moshi, Tanzania
%A A D Bezuney
%A A E Groeneveld
%A C F Heyns
%J African Journal of Urology
%D 2007
%I 
%X Objective: The aim of this study was to audit the treatment outcome of children with Wilms' tumor in East Africa, at a Urology referral center with limited access to imaging modalities and chemotherapeutic drugs, and no radiation facility. Patients and Methods: This is a retrospective analysis of the hospital records of children with a diagnosis of Wilms' tumor treated from June 1996 to May 2005 at the Association of Surgeons of East Africa (ASEA) Institute of Urology, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania. Results: In total, 50 patients were diagnosed with Wilms' tumor in the 9 years study period, but only 39 files contained sufficient information for analysis. The average age at presentation was 44.7 months (median 36, range 8 to 120 months). 25.6% of the children were >60 months old. The male:female ratio was 1.4:1. All of the children presented with an abdominal mass detected by the parents. The hemoglobin was <100 gm/L in 21 (53.8%) and the platelet count was >450,000/ml in 8 (20.5%) cases. Ultrasound imaging was obtained in all cases, but CT imaging was not taken. Intravenous urography was done in 38 children and showed non-visualization of the involved kidney in 16 (42.1%). Fine needle aspiration cytology (FNAC) was performed in 25 cases and was diagnostic in 23 (92%). Preoperative vincristine and dactinomycin was given to 23 patients (59%) with marked tumor shrinkage in 20 (87%), while 3 (13%) showed no response. Radical nephrectomy was performed in all patients, and 3 patients (7.7%) died within 24 hours of surgery. Pathologic analysis showed favorable histology in 35 (89.7%) and unfavorable histology in 4 (10.3%) patients. Based on the pre- and intra-operative findings, NWTS stage 1, 2, 3, 4 and 5 was present in 25.6%, 17.9%, 15.4%, 38.5% and 2.6%, respectively. Postoperative dactinomycin and vincristine was given monthly for one year in all patients, while doxorubicin and cyclophosphamide were reserved for those with no response to the first-line drugs, or recurrent tumor. Radiotherapy was not available. At 12 months' follow-up the overall disease-free survival was 35.9%, recurrence had occurred in 38.5%, death in 15.4%, and 10.3% were lost to follow-up. Conclusion: Children with Wilms' tumor in East Africa still have a dismal prognosis, with treatment outcomes at levels where it was before the advent of chemotherapy and radiation therapy in more advanced centers. Objectif : Le but de cette ¨¦tude ¨¦tait d'¨¦valuer les r¨¦sultats du traitement des enfants pr¨¦sentant une tumeur de Wilms en Afrique de l'Est, dans un centre de r¨¦f¨¦rence d'urologie avec un acc¨¨s limit¨¦ ¨¤ l'imagerie m¨¦dicale et aux drogues chimioth¨¦rapeutiques, et aucun service de radioth¨¦rapie. Patients et m¨¦thodes : C'est une analyse r¨¦trospective des dossiers m¨¦dicaux d'enfants pr¨¦sentant une tumeur de Wilms trait¨¦s de juin 1996 ¨¤ mai 2005 ¨¤ l'h pital de l'association des chirurgiens de l'Afrique de l'Est, institut d'urologie ( ASEA), le centre m¨¦dical
%U http://www.ajol.info/index.php/aju/article/view/8172