[Comparative evaluation of preoperation transcatheter arterial chemoembolization in children with advanced wilms...

Objective: To evaluate the therapeutic effect and prognosis of preoperative transcatheter arterial chemoembolization (TACE), transcatheter arterial chemoembolization (TAIC), preoperative intravenous chemotherapy for children with advanced stage nephroblastoma. Methods: From January 2007 to December 2018, according to different treatment protocols before surgery, children with nephroblastoma were divided into 3 groups, which were TACE group (44 cases), TAIC group (7 cases) and intravenous chemotherapy group (9 cases) in Children's Hospital, Zhejiang University School of Medicine. The imaging examination, treatment safety and long-term efficacy of these three groups before and after treatment were compared. Observed indicators include tumor debulking rate, envelope integrity rate, necrosis rate, postoperative adverse reactions and follow-up. Results: Tumor debulking rate: tumor of TACE group decreased 46.5%, TAIC group shrinked 28.3%, and intravenous chemotherapy group reduced by 23.3%, the difference of tumor shrinkage between TACE group and intravenous chemotherapy group was statistically significant (P<0.05). Tumor necrosis rate: necrotic area in TACE group was about 46.0%-95.4%, average 75.1%±12.5%, while in intravenous chemotherapy group was 65.8%±8.7%, the difference was statistically significant (P<0.01). The tumor membrane integrity rate of these three groups were 86.4%(38/44),5/7 and 6/9 respectively, and difference between TACE group and intravenous chemotherapy group was significant (P<0.05). Patients who had myelosuppression each was 5 in TACE group (5/44), 4 in TAIC group (4/7), and 8 in intravenous chemotherapy group (8/9), and there were significant differences. Follow-up time and tumor-free survival rate in each group were respectively 20 to 92 months (median time 64 months) and 95% in TACE group, 12 to 69 months (median time 30 months) and 43.0% in TAIC group, and 16 to 72 months (median 28 months) and 56.0% in intravenous chemotherapy group. Conclusions: Preoperative TACE can lead to tumor shrinkage and necrosis more obviously, systemic adverse reactions are small, also the tumor complete resection rate is higher and the operation is safer.The survival rate can be effectively improved and more suitable for clinical treatment.