ORIGINAL ARTICLE S. Sen á P. Kadamba á M. Al-AbdulAaly K. E. Mammen á S. Ahmed Results of Wilms' tumour management in two tertiary-care hospitals in Asia Accepted: 16 December 1996 Abstract In the period 1985±1995, 87 children under- went surgery for Wilms' tumour; 16 were lost to follow- up. Of the remaining children, 27 presented with stage I disease, 11 with stage II, 12 with stage III, 14 with stage IV, and 6 with stage V. One child was not staged. The histology was favourable Wilms' tumour in 44, ana- plastic in 12, unclassi®ed in 8, clear-cell sarcoma in 4, and rhabdoid tumour in 3. Although a total nephrec- tomy was generally performed, partial renal surgery was performed for 6 bilateral and 4 unilateral tumours, the latter including 2 fused kidneys. Preoperative chemo- therapy was employed with bene®t in massive tumours, tumour in fused kidneys, bilateral tumours, and preop- eratively diagnosed inferior vena caval tumour thrombi. Postoperative chemotherapy, employed in all cases, consisted of actinomycin D and vincristine with the addition of adriamycin in anaplastic and advanced-stage tumours. Ten children underwent second-line chemo- therapy for disease unresponsive to the above manage- ment, but only 1 of these is currently free of disease. Postoperative tumour-bed radiotherapy, used in selected cases, prevented local recurrence in stage I and II dis- ease. However, 20% of stage I and II patients not re- ceiving radiotherapy developed tumour-bed recurrence. Twenty-three children have died and 5 with advanced disease and incomplete follow-up are presumed to be dead. Nine children are currently on treatment; 34 have successfully completed treatment, the disease-free sur- vival in stages I±V being 81%, 75%, 42%, 14%, and 50%, respectively. Overall disease-free survival was 69% for Wilms' tumour of favourable histology and 50% for anaplastic tumours. The 3 patients with rhabdoid tu- mours and 3 of 4 with clear-cell sarcomas have died. Wilms' tumour management in the developing world is compromised by cases lost to follow-up and late pre- sentation with massive tumours and advanced stage. Preoperative chemotherapy is advantageous in a number of cases, and postoperative radiotherapy should be de- ployed more frequently. Key words Chemotherapy á Nephrectomy á Radiotherapy á Wilms' tumour Introduction Wilms' tumour (WT) is a common childhood neoplasm of worldwide distribution. High cure rates have been achieved in the developed world, where the current goal of further research is to curtail surgery, radiotherapy, and chemotherapy without compromising the results [2, 4]. We reviewed 87 children with WT from two Asian tertiary-care hospitals. The overall results were rather poor, being compromised by late presentation, massive tumours, and poor follow-up. Contemporary protocols of management of WT need modi®cation for improved survival. Materials and methods Fifty-four children with WT managed surgically from Christian Medical College Hospital, Vellore, India (1985±1995) and 33 from King Faisal Specialist Hospital, Riyadh, Saudi Arabia (1988±1995) were reviewed; 16 patients, though free of gross disease when last seen, were lost to follow-up with incomplete therapy and are ex- cluded. The results in 71 patients, including 40 males and 31 fe- males with an age range of 6 weeks to 15 years, were analysed. Staging at diagnosis/surgery showed stage I:27, stage II:11, stage III:12, stage IV:14, stage V:6, and 1 child presented with a recurrent renal-bed tumour after a nephrectomy elsewhere. Tumour in the inferior vena cava (IVC) or beyond was diagnosed preoperatively in 5 cases, including 1 child with a rhabdoid tumour [1]. Forty-four patients had WT of favorable histology, 12 had anaplastic tumours, 4 had clear-cell sarcoma (CSS), and 3 had rhabdoid tumours. In 8 children with WT, the histology was unclassi®ed with regard to the degree of anaplasia. Pediatr Surg Int (1998) 13: 42±44 Ó Springer-Verlag 1998 S. Sen á P. Kadamba á K.E. Mammen Department of Paediatric Surgery, Christian Medical College and Hospital, Vellore, India S. Sen á M. Al-AbdulAaly á S. Ahmed (&) Department of Surgery (MBC-40), King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh, Saudi Arabia