Multimodality management of unilateral wilms' tumor in children : a better guidance by histopathological examination

الملخص EN

-Background .'Although wilms' tumor is among the most common primary malignant tumors in childhood, controversy still exists regarding its best mode of treatment.

Aim:This study aimed at comparing the results of two different protocols in treatment of wilms tumor in three different institutes.

Patients and Methods:Twenty four children were included in this study .

Inclusion criteria were ; localized disease , histologically confirmed wilms’ tumor or clinical , ultrasonic and CT characteristics of nephroblastoma .

Children were divided into two equal groups in each institute .In group I (n = 12) preoperative chemotherapy was initiated according to ultrasonic and CT diagnosis , whereas in group II (n = 12) chemotherapy was decided according to surgical staging and biopsy .Radical excision of the tumor was done when amenable; however, in those with residual masses, metal clips were left to identify them in follow up .

Results: In group I, 7 patients were preoperativeiy diagnosed as stage II, while the remaining 5 patients were preoperativeiy diagnosed as being stage 111 .

Postoperatively one patient was found to be stage II instead of being stage III before chemotherapy .

In group II, 9 patients were proved to be stage II, whereas 3 patients were stage III .

The postoperative follow-up was identical for both groups .Yet, in group I, 2 patients with stage II disease (25%), showed CT evidenced recurrences .

Complete remission was noted in 3 out of the 4 stage III patients (75 %) , the remaining one showed poor response to treatment and died with disease .

In group II, one patient with stage II (11.1%) showed C.T evidence of recurrence , salvaged with chemotherapy and radiotherapy .

Also, one patient with stage III showed relapse (33.3%), and respond moderately to second chemotherapy and still living with disease .

Conclusion: We have recommended that stage I and II, disease is better managed according to NWTSG recommendations , whereas preoperative chemotherapy is reserved to higher stages III, IV and bilateral disease .

Key Words : Wilms tumour, Children, Chemotherapy and Surgery