Clinical features and treatment strategies of Wilm's tumor: A setup in the last decade of the millennia and possible inclusion of advance researches to improve the clinical management

This is a study of 20 cases of Wilms' tumor studied over a period of 3 years covering different hospitals of Karnataka in India. Although the study was concluded in the year 2000, it was found worthwhile to demonstrate that inclusion of the results of advance researches can improve the management of Wilms' tumor. This is to highlight the bitter realities that the little patients succumb to harsh disease just because the facilities of research developments do not reach the hospitals. The presentation of our study would show if the modem researches on (i) expression of genes and receptors (ii) immunological assays (iii) microarray technology would have been available, there would have been reduction in mortality. In this study during the last three years of 2000, the patients were studied in detail by taking history and clinical examination. Specific investigations like ultrasound of the abdomen, FNAC, CT scan, in addition to routine investigations were carried out. Treatment modalities included surgical treatment like nephrectomy, partial nephrectomy, chemotherapy and radiotherapy depending on the staging. The results of this study showed that (i) the stage I and II cases have good prognosis if detected early and managed aggressively (ii) that CT scan did not show any superiority over ultrasound evaluation except for the fact that it delineated internal characters of the tumor better (iii) Surgery could be performed successfully in all patients without any morbidity and mortality and (iv) Wilms' tumor responds very well to combination chemotherapy. However; recurrence, toxicity and mortality were difficult to be avoided. It is suggested that World Health Authorities may take a decision to implement the developments in researches for clinical management of Wilms' tumor to farthest hospitals in any country.