Abstract
Background: The survival rate of Wilms tumour (WT) in low-income sub-Saharan countries in Africa is below 50%. Thirty-five consecutive children diagnosed with WT between 2007 and 2012 at Mbingo Baptist Hospital, Cameroon, were observed in this study and treated with a modified International Society of Paediatric Oncology (SIOP) treatment protocol. Aim: Our objective was to achieve a significant overall cure rate in patients with WT. Setting: This report describes the long-term outcome of patients treated at Mbingo Baptist hospital (MBH) in northwest Cameroon. Method: This consisted of preoperative chemotherapy, nephrectomy and post-operative chemotherapy depending on the stages of the disease and histological findings. Radiotherapy was not available. The diagnosis and staging was based on abdominal ultrasound (US), chest X-Ray and the histological findings at nephrectomy and surgery and/or fine needle aspirate (FNA). The cohort included 17 boys and 18 girls with a median age of 3.5 years (range 6 months to 9 years). The surgical stage distribution was: stage I = 9; II = 3; III = 5; IV = 12; V = 3; undetermined = 3 patients. Results: Three guardians refused surgery; there were three deaths related to surgery and two deaths during preoperative chemotherapy. All relapses occurred within 12 months. The survival rate was significantly better in stages I and II than in stages III and IV of cancer. Two of the three patients with bilateral WT are long-term survivors. The overall projected survival rate after a median follow-up of 84 months (range 4–125 months) was 44%. One patient in remission was lost to follow-up after 4 months. All patients admitted with a diagnosis of WT were included in the Kaplan–Meier survival analysis. Conclusion: With this treatment schedule followed for more than 50% of the patients, it can be concluded that obtaining consent from every guardian for nephrectomy and preventing deaths related to surgery and chemotherapy could improve the overall survival rate of all patients diagnosed with WT.
Highlights
The reported survival rate for Wilms tumour (WT) in low-income sub-Saharan countries varies from 0% to 46% when using preoperative chemotherapy, compared to more than 85% in high-income countries.[1,2,3]
This report describes the long-term outcome of patients treated at Mbingo Baptist hospital (MBH) in Northwest Cameroon
Guardians gave informed consent to participate in the study and ethical approval was obtained from the Cameroon Baptist Convention Health Board (CBCHB) institutional review board
Summary
The reported survival rate for Wilms tumour (WT) in low-income sub-Saharan countries varies from 0% to 46% when using preoperative chemotherapy, compared to more than 85% in high-income countries.[1,2,3] This report describes the long-term outcome of patients treated at Mbingo Baptist hospital (MBH) in Northwest Cameroon. Cameroon is a low-income country with limited resources for cancer treatment. The survival rate of Wilms tumour (WT) in low-income sub-Saharan countries in Africa is below 50%. Thirty-five consecutive children diagnosed with WT between 2007 and 2012 at Mbingo Baptist Hospital, Cameroon, were observed in this study and treated with a modified International Society of Paediatric Oncology (SIOP) treatment protocol
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