Outcome of children with Wilms' tumor in Duhok city, Kurdistan region, North of Iraq

Abstract

Wilms' tumor is a curable disease in most of the affected children. The treatment has been improved in the past two decades, with the aid of multimodal therapy protocols. The aims of this study were to evaluate the treatment results, and to assess the survival and the principal prognostic factors in children with Wilms' tumor in Duhok city, Kurdistan region, North of Iraq. Forty-two children diagnosed as having Wilms' tumor in the period between August 1999 and August 2006, who received their treatment at Hevi pediatric teaching Hospital, were studied. Information relating to the patients and the characteristics of the tumor were evaluated. All patients were treated surgically by nephrectomy, followed by postoperative chemotherapy, without radiotherapy (not available), depending on the stage of the tumor, and according to the National Wilms' Tumor Study (NWTS) protocols. Of these 42 patients, 25 were males and 17 were females (male-to-female ratio =1.47:1). The median age at the time of diagnosis was 33 months. The distribution of patients according to the surgical stage was: stage I: 30.9%, stage II: 26.2%, stage III: 35.7%, stage IV: 7.1%. Favorable histology was diagnosed in 69% and unfavorable histology (focal or diffuse anaplasia) in 31% of the patients. Tumor relapse was seen in 12 patients (28.5%). After 4 years follow up, 29 cases (69%) were alive free of disease, two cases (4.7%) were alive with disease and 11 cases (26.2%) had died. The disease-free survival and the overall survival rates at 4 years were 69% and 73.8%, respectively. As a developing country, with limited diagnostic facilities and inadequate facilities for standard management, we believe that our survival rates, although lesser than a number of similar studies survival, were acceptable. Further research with more comprehensive investigation is recommended to improve the treatment results.