Primary Surgery in Treatment of Stages II and III Wilms' Tumour: A Developing Countries' Experience
O M Zakaria1,2, E N Hokkam2, K Al Sayem2
1Department of Surgery, college of Medicine, King Faisal University, KSA.
Insights
Primary surgery for Wilms' tumour (WT) in stages II and III is more effective than neoadjuvant chemotherapy. This approach improves treatment outcomes and reduces costs in developing countries.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Global Health
Background:
- Wilms' tumour (WT) treatment is costly, impacting healthcare budgets, especially in resource-limited settings.
- Developing countries face significant challenges in affording and implementing current WT treatment protocols.
Purpose of the Study:
- To evaluate the effectiveness of primary surgery versus neoadjuvant chemotherapy for stage II and III pediatric WT.
- To assess treatment outcomes based on the National Wilms' Tumor Study (NWTS-4) schedule in developing countries.
Main Methods:
- A comparative study of 40 children with stage II/III WT, divided into two groups.
- Group I: Neoadjuvant chemotherapy followed by surgery. Group II: Primary surgery followed by chemotherapy.
- Clinical and radiological evaluations (CT scans) were performed after a mean follow-up of 20 months.
Main Results:
- No recurrence was observed in stage II WT patients treated with primary surgery (Group II), compared to 4 in the neoadjuvant chemotherapy group (Group I).
- Stage III WT showed a lower rate of tumor size increase (rebound) in the primary surgery group (1 patient) versus the neoadjuvant group (2 patients).
Conclusions:
- Primary surgery with adjuvant therapy offers superior treatment results for stage II and III WT compared to neoadjuvant chemotherapy.
- This approach is a safe, effective, and potentially cost-saving strategy for managing WT in developing nations.
Background:
Treatment options for Wilms' tumour (WT) are costly and it affects the country's health budget and resources if adopted and implemented at the national level especially in developing countries with low or resource-challenged settings.
Aim:
The objective of this study is to evaluate the role and effectiveness of primary surgery in the treatment of stage II and III pediatric WT following the schedule indicated in the National Wilms' Tumor Study (NWTS-4) in the institutes of two developing countries.
Patients And Methods:
The study enrolled 40 children who were primarily diagnosed as stage II and III WT. They were divided into 2 equal groups. Group I (n = 20) included those children who have undergone neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy, while group II (n = 20) included those children who have undergone primary surgery as an initial management followed by chemotherapy. After a mean postoperative follow-up period of 20±5 months, clinical and radiological evaluation was performed for all patients.
Results:
In group I, 15 patients were preoperatively diagnosed as stage II and 5 patients as stage III while in group II, 16 patients were proved to be stage II and 4 patients were stage III. After a follow up period, clinical and radiological evaluation using CT was performed on all patients. In patients with stage II, evidence of recurrence was noted in 4 patients of group I whereas no patient showed any evidence of recurrence in group II. In patients with stage III, rebound increase in size was seen in 2 patients in group I and only one patient in group II.
Conclusion:
Primary surgery with appropriate adjuvant therapy improves the treatment results compared to the neoadjuvant chemotherapy and delayed surgery for children primarily diagnosed as stage II and III WT. It may be used as a safe and effective tool in treating WT patients with relatively no changes from the long administration schedules. This will have a highly positive impact in lowering treatment cost in developing countries.
