Related Experiment Video
Updated: Jan 7, 2026
Implementation of Minimally Invasive Brain Tumor Resection in Rodents for High Viability Tissue Collection
Published on: May 9, 2022
Wilms Tumor Management: A Systematic Review Comparing SIOP and NWTS/COG Protocols in Diagnosis, Treatment, and
Andika Abdul Rahim Damanik1, Taufiq Nur Budaya1, Kurnia Penta Seputra1
1Department of Urology, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar General Hospital, Malang, Indonesia.
Introduction:
Wilms tumor is the most common pediatric renal malignancy, with two predominant management approaches creating clinical decision-making challenges. SIOP advocates preoperative chemotherapy to reduce tumor burden, while NWTS/COG prioritizes immediate surgery for histopathological analysis. Evidence-based comparison is essential, particularly in resource-limited settings.
Objective:
To systematically compare preoperative chemotherapy (SIOP) versus upfront nephrectomy (NWTS/COG) protocols in Wilms tumor management by analyzing diagnostic accuracy, treatment efficacy, and surgical outcomes through direct comparative studies.
Methods:
A PRISMA 2020-guided systematic review was conducted, searching PubMed, ScienceDirect, SpringerLink, and Google Scholar for comparative studies (2015-2024) that directly compared SIOP and NWTS/COG protocols in pediatric Wilms tumor patients. Quality assessment was performed using the ROBINS-I tool.
Results:
Four comparative studies encompassing 226 patients from developing countries (India, Pakistan, Iraq, Vietnam) were included. Diagnostic accuracy varied significantly, with SIOP protocols showing misdiagnosis rates of 17.4-21.7% in resource-limited settings, while NWTS protocols achieved 100% accuracy in the single study reporting this outcome. Surgical outcomes were heterogeneously reported: one Indian study found no intraoperative spillage in SIOP patients (0/23) versus 22.2% in NWTS patients (2/9), though this finding cannot be generalized due to single-center limitations. Postoperative complications varied by setting, with one Pakistani study reporting higher rates in SIOP patients (21% vs. 9.5%). Survival outcomes ranged from 80.9-96.7% across protocols and countries, with no consistent pattern favoring either approach.
Conclusion:
Neither protocol demonstrates consistent superiority across all outcomes. Protocol selection should be individualized based on disease stage, diagnostic capabilities, and healthcare infrastructure. The limited number of comparative studies and heterogeneous reporting highlight the need for standardized outcome measures and larger multicenter trials.
Related Concept Videos
02:56Treatment Resistant Cancers
02:49Cancer Therapies
However, cancer treatments can pose several challenges, as therapies used to kill cancer cells are generally also toxic to normal cells. Moreover, cancer cells mutate rapidly and can develop resistance to chemical agents or radiation therapy. Besides, all types of cancer cells may not respond to the same therapy. Some cancer cells respond to one...