Discussion
This study reflects the situation in the largest oncology hospital in
Sudan. Compared to previous studies, the subject number is reasonably
large, and the duration of follow up is longer. It is the largest data
from Sudan about the outcome of Wilms’ tumor using the NWTS 4 protocol.
It identifies many problems that face Wilms tumor management. The
incidence of Wilms tumor in our study is (5.7%). The incidence, age,
and sex distribution are comparable to most international studies and
other Low-income countries (LIC) countries 5, 6,7,
8,9. However, these figures are drawn from hospital-based records and
might not reflect the population incidence.
Most of our patients presented with advanced disease stage. Stage 3 and
4 constituted (83 %) of all cases. This is in contrast to other more
extensive studies that have the bulk of their patients presenting with
early-stage disease 10. It is also higher than other
low income and middle-income countries 5,8,11,12,13,14Favorable histology is the most common (86%). It is consistent with a
study by Hoda M Awadalla. In their study, 82.2 % of Wilms tumor in
Sudanese children was the favorable triphasic type 15
Primary nephrectomy is the most frequent type of surgery. All surgeries
are performed outside the hospital. There is a significant delay in
doing the surgery due to the long waiting lists. There is also a delay
in obtaining the histopathology report. Much information is collected
through personal communication and imaging. It takes at least one month
after surgery to start chemotherapy and radiotherapy.
Pre-operative chemotherapy, followed by nephrectomy appears to be a
reasonable approach. The fact that there are no surgical facilities at
the hospital makes it difficult to adapt the SIOP pre-operative
chemotherapy. Many patients who received neoadjuvant chemotherapy had
significant delays when referred for surgery. In some cases, the tumor
increased in size significantly. This approach is also challenging to
adapt too. Pre-operative chemotherapy seems the right strategy, but it
is not possible to use it now. A project to establish a surgical unit
has inside the hospital has started.