REALITY OF TREATMENT IN PATIENTS WITH NEPHROBLASTOMA WHO IMMEDIATE TUMOR AND KIDNEY RESECTION BEFORE CHEMOTHERAPY AT THE VIETNAM NATIONAL CHILDREN’S HOSPITAL REALITY OF TREATMENT IN PATIENTS WITH NEPHROBLASTOMA WHO IMMEDIATE TUMOR AND KIDNEY RESECTION BEFORE CHEMOTHERAPY AT THE VIETNAM NATIONAL CHILDREN’S HOSPITAL
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Abstract
Objective: To analyze the clinical characteristics, investigation fndings and evaluate the treatment outcomes of patients treated under the NWTS-5 protocol from 2017 to 2023, as
well as propose solutions to improve nephroblastoma treatment outcomes.
Methods: A retrospective case series study.
Results: 30 patients underwent immediate surgery followed by postoperative chemotherapy under the NWTS-5 protocol, accounting for 22.3% among patients with nephroblastoma for seven years. The median age at diagnosis was 16 months (ranging from 18 days to 50 months). The male-to-female ratio was 2.3:1. The most common reasons for hospital admission were palpable abdominal tumors, abdominal distension, and hematuria. The median preoperative tumor size based on imaging was 256.2 cm³, while the median tumor volume at surgery was 297 cm³. The most common histological type was the mixed type (66.7%). Stage I accounted for 63.3%, stage II for 23.3% and stage III for 13.3%, with all cases classifed as intermediate risk. The median time from diagnosis to surgery was 9.5 days. Ten patients (33.3%) had a statistically signifcant increase in tumor size at the time of surgery with a mean surgical waiting time of 10.4 days, including 2 patients with stage III disease. The mean surgical waiting time of 4 patients with stage III disease was 13 days (11-19 days). The 5-year overall survival (OS) rate was 95.5%, and the 5-year event-free survival (EFS) rate was 92.5%. There was one case of recurrence (3.3%), in which the patient continued treatment and survived. Another patient abandoned treatment after surgery and subsequently died.
Conclusion: Among nephroblastoma patients, 22.3% were treated under the NTWS-5 protocol (immediate surgical). Theses patients had a younger age at disease, small tumor sizes, and high overall and event-free survival rates. To improve the treatment results of nephroblastoma at the National Children’s Hospital, it is necessary to perform additional tumor genetic tests and apply a preoperative chemotherapy regimen (SIOP Umbrella).
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Keywords
Wilms tumor, nephroblastoma, immediate surgery before chemotherapy, NTWS-5 protocol
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