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[Problems of nephroblastoma in children]
Insights
Wilms tumor is frequently diagnosed at advanced stages in children. Effective treatment involves polychemotherapy and irradiation, significantly improving survival rates for advanced Wilms tumor cases.
Area of Science:
- Pediatric Oncology
- Nephrology
- Cancer Research
Context:
- Wilms tumor (nephroblastoma) is the most common primary renal malignancy in children.
- This study evaluated 388 Wilms tumor cases over 13 years, focusing on disease staging, metastasis, and treatment outcomes.
- A significant proportion of pediatric patients presented with advanced stage disease (II-IV).
Purpose:
- To analyze the staging, metastatic patterns, and survival rates of Wilms tumor in a pediatric cohort.
- To evaluate the effectiveness of current therapeutic strategies, including polychemotherapy and irradiation.
- To identify factors influencing prognosis and optimize treatment protocols for advanced Wilms tumor.
Summary:
- The study identified a high incidence of advanced Wilms tumor stages (II-IV) at diagnosis, with 40.5% presenting with detectable metastases.
- Metastases were most common at stage III and often detected within the first year of therapy.
- Survival rates after 3 years were 28.9% overall, with significant variations by stage (Stage II: 57.1%, Stage III: 25.4%, Stage IV: 4.6%).
Impact:
- Pre- and postoperative polychemotherapy for 1.5-2 years demonstrated efficacy.
- Combined modality treatment, including irradiation for stage III tumors, improved 3-year survival rates to 69.5% for stage II and 32.3% for stage III.
- Findings underscore the need for early detection and tailored treatment strategies for pediatric Wilms tumor to improve patient outcomes.
Abstract:
An evaluation of 388 cases of Wilms tumor within 13 years established a high proportion of advanced cases among children: stage II - 30.6; III - 35.4; IV - 27.6 and V (bilateral) - 6.4%. Main homeostatic indices remained unchanged until stages III-IV. Primary tumor and metastases can be detected by a complex of clinical, X-ray and radioisotope methods the effectiveness of which is determined by degree of tumor extension. Dissemination of tumor at different sites were detected by primary examination in 40.5% and at later stages in 15% of patients. Most metastases (96%) were detected within the first 12 months of therapy. They were significantly more frequent at stage III and their frequency was in correlation with the patient's age at the time of tumor detection. Out of 388 cases, 112 (28.9%) survived for more than 3 years, stage II - 57.1; stage III - 25.4 and stage IV - 4.6% included. 1.5 - 2 year-long courses of pre- and postoperative polychemotherapy proved to be effective, whereas in cases of stage III tumor they should be supplemented with irradiation of primary tumor, its bed, regional lymph collectors and metastases. These measures ensured a 3-year survival in 69.5% of stage II patients and in 32.3% of stage III patients.