Relapsed Wilms’ tumor in pediatric patients: challenges in low- to middle-income countries—a single-center experience

Abstract

Background Wilms’ tumor (WT) affects one in 10,000 children and accounts for 5% of all childhood cancers. Although the overall relapse rate for children with WT has decreased to less than 15 %, the overall survival for patients with recurrent disease remains poor at approximately 50 %. The aim of the study to evaluate the outcome of relapsed Wilms’ tumor pediatric patients treated at the National Cancer Institute (NCI), Egypt, between January 2008 and December 2015. Results One hundred thirty (130) patients diagnosed with WT during the study period, thirty (23%) patients had relapsed. The median follow up period was 22.3 months (range 3.6–140 months). The Overall Survival (OS) was 30.9% while the event-free survival (EFS) was 29.8% at a 5-year follow up period. Median time from diagnosis to relapse was 14.4 months. A second complete remission was attained in 18/30 patients (60%). The outcome of the 30 patients; 11 are alive and 19 had died. Three factors in our univariate analysis were prognostically significant for survival after relapse. The first was radiotherapy given after relapse (p = 0.012). The 5-year EFS and OS for the group that received radiotherapy were 41.9% versus 16.7% and 11.1% respectively for those that did not. The second was the state of lymph nodes among patients with local stage III (p = 0.004). Lastly, when risk stratification has been applied retrospectively on our study group, it proved to be statistically significant (p = 0.029). Conclusion Among relapsed pediatric WT, radiotherapy improved survival at the time of relapse and local stage III with positive lymph nodes had the worst survival among other stage III patients.

Lung relapse pattern in children with metastatic Wilms tumor

“…We analyzed only seven patients, but the number of children with metastatic WT at diagnosis and lung relapse is limited and ours is in the range of similar studies 12 . Additionally, the relapse rate of 27% in this small cohort was higher than 15% 11 for WT, but our relapse rate was based on children with stage IV disease and this might have increased relapse rate in our series.…”

“…10 Relapse of WT is uncommon due to the high success rates of treatment, occurring in 15% after treatment 11 and mainly involving lungs (80% of cases). [12][13][14] The risk of pulmonary recurrence depends on several factors, including disease extension at diagnosis, response to Abbreviations: CT, computed tomography; SD, standard deviation; SIOP, International Society of Pediatric Oncology; WT, Wilms tumor. treatment, and time elapsed since the initial treatment.…”

“…Relapse of WT is uncommon due to the high success rates of treatment, occurring in 15% after treatment 11 and mainly involving lungs (80% of cases) 12‐14 . The risk of pulmonary recurrence depends on several factors, including disease extension at diagnosis, response to treatment, and time elapsed since the initial treatment 11,15,16 .…”