Zakaria Ossama M, Hokkam Emad N, Sayem Karam Al, Daoud Mohamed Yasser I, Zakaria Hazem M, Sedky Fouad, Graiz Seba H, Moussa Saleh A, Wadaani Hamed A Al
Department of Surgery, College of Medicine, King Faisal University, Al Ahsa, KSA.
Department of Surgery, College of Medicine, Dammam University, KSA.
World J Oncol. 2015 Oct;6(5):441-445. doi: 10.14740/wjon876w. Epub 2015 Oct 26.
Although Wilms' tumor (WT) is ranked first among primary childhood's renal neoplasm, controversy still exists regarding the best approach for its management. The study aimed at evaluating the role of initial surgery in treatment of stage II and III pediatric WT as a part of the short administration schedule as in National Wilms' Tumor Study (NWTS)-4 and evaluating its effectiveness compared to the long administration schedule.
The study included 30 children who were primarily diagnosed as stage II and III WT. They were divided into two equal groups. Group I (n = 15) included those children who had undergone neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy, while group II (n = 15) included those children who had undergone primary surgery as an initial management followed by chemotherapy. After a mean postoperative follow-up period of 14 ± 5 months, clinical and radiological evaluation was performed to all patients.
In group I, 10 patients were preoperatively diagnosed as stage II and five patients as stage III while in group II, 11 patients were proved to be stage II and four patients were stage III. After a follow-up period, clinical and radiological evaluation using CT was performed to all patients. In patients with stage II, evidence of recurrence was noted in three 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 two patients in group I and only one patient in group II.
Initial surgical intervention with appropriate adjuvant therapy has better outcomes than the neoadjuvant chemotherapy and delayed surgery for children primarily diagnosed as stage II and III WT. Moreover, it may act as a short administration schedule for the treatment as it is not less effective than the long administration schedule and can be administered at a substantially lower total treatment cost.
尽管肾母细胞瘤（WT）在儿童原发性肾肿瘤中排名第一，但对于其最佳治疗方法仍存在争议。本研究旨在评估初始手术在治疗Ⅱ期和Ⅲ期小儿WT中的作用，作为国家肾母细胞瘤研究（NWTS）-4中短疗程治疗方案的一部分，并与长疗程治疗方案相比评估其有效性。
该研究纳入了30名最初被诊断为Ⅱ期和Ⅲ期WT的儿童。他们被分为两组，每组15人。第一组（n = 15）包括那些接受新辅助化疗后进行手术及术后化疗的儿童，而第二组（n = 15）包括那些以初始手术作为首要治疗手段，随后进行化疗的儿童。术后平均随访14±5个月后，对所有患者进行临床和影像学评估。
在第一组中，术前诊断为Ⅱ期的患者有10例，Ⅲ期的患者有5例；而在第二组中，经证实为Ⅱ期的患者有11例，Ⅲ期的患者有4例。随访期结束后，对所有患者进行了CT临床和影像学评估。在Ⅱ期患者中，第一组有3例出现复发迹象，而第二组没有患者出现复发迹象。在Ⅲ期患者中，第一组有2例出现瘤体大小反弹增加，第二组只有1例。
对于最初诊断为Ⅱ期和Ⅲ期WT的儿童，初始手术干预联合适当的辅助治疗比新辅助化疗和延迟手术具有更好的治疗效果。此外，它可作为一种短疗程治疗方案，因为其疗效不低于长疗程治疗方案，且总治疗成本可大幅降低。
