[Problems of nephroblastoma in children].

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.