title: Preoperative chemotherapy for patients with Wilms tumor in Malawi is feasible and efficacious.
abstract: BACKGROUND
  Wilms tumor has a survival rate of 85-90% in well resourced countries but in low income countries survival is lower. Malawi is a country with very limited resources. We studied the feasibility, toxicity and efficacy of preoperative chemotherapy for Wilms tumor in Malawian children.
  
  
  METHODS
  All patients diagnosed with a Wilms tumor, admitted in Blantyre, Malawi, from 2006 to 2008, were included. These patients received SIOP-based preoperative chemotherapy followed by surgery and risk-stratified post-operative chemotherapy. Social support and counseling were provided to prevent abandonment of treatment.
  
  
  RESULTS
  Twenty patients were included. Mean tumor volume at diagnosis was 2,500 ml and eight patients (40%) had metastases. Ninety-five percent of patients presented with hypertension, 80% with microscopic hematuria and 60% with a raised platelet count. Preoperative chemotherapy resulted in >50% tumor reduction in 55% of patients with localized disease and 75% of patients with metastatic disease. During preoperative chemotherapy, 11 of 18 patients experienced >or= grade 3 anaemia, 7 patients experienced >or= grade 3 neutropenia. In 12 patients the tumor was resected. Reasons of treatment failure were: abandonment of treatment (N = 3), death during anaesthesia induction (N = 1), inoperability (N = 5, due to metastatic disease in N = 4) and relapse (N = 2). One patient died of malaria 2 months after completion of chemotherapy. Eight patients (40%) are alive with a median follow up of 8 months (range 0-1.5 years).
  
  
  CONCLUSIONS
  Preoperative chemotherapy for Wilms tumor is feasible, tolerated and efficacious in Malawi. Continued efforts are needed to encourage early presentation and to prevent abandonment.
authors.affiliation: Department of Paediatrics, College of Medicine, University of Malawi, Blantyre, Malawi. trijnisraels@hotmail.com
authors.forename: Trijn
authors.initials: T
authors.lastname: Israëls
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Molyneux
authors.forename: Huib N
authors.initials: HN
authors.lastname: Caron
authors.forename: Monica
authors.initials: M
authors.lastname: Jamali
authors.forename: Kondwani
authors.initials: K
authors.lastname: Banda
authors.forename: Hans
authors.initials: H
authors.lastname: Bras
authors.forename: Steve
authors.initials: S
authors.lastname: Kamiza
authors.forename: Eric
authors.initials: E
authors.lastname: Borgstein
authors.forename: Jan
authors.initials: J
authors.lastname: de Kraker
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D009396:Wilms Tumor / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents