Effect of Preoperative Chemotherapy in Reduction of Tumor Volume in Wilms Tumor in Relation to Histology

Abstract

Background: Wilms tumor (WT) is the most common renal tumor in children under5 years. The survival rates of children with Wilms tumor have improved dramatically over a few decades. Objective: To find out the effect of preoperative chemotherapy in the reduction of tumor volume in Wilms tumor and its correlation with tumor histology.

Methodology: A total of 53 patients diagnosed with WT under 15 years were enrolled. After a complete history and physical examination, all information including demographics, metastatic status, pre and post-chemotherapy volume, histology, postop stage and surgical complication was collected and entered on Performa. All patients received neo-adjuvant chemotherapy according to the SIOP protocol. Data was entered and analyzed in SPSS 23.

Results: Fifty-three patients were included. There were 33 (62.3%) male and the mean age was 4.45 +2.2 years. Thirty-two (60.4%) children had localized disease and13 (24.5%) children had lung metastasis. There was a significant reduction of tumor volume of >500ml in 8(15.1%) patients after preoperative chemotherapy and the majority 18(34 %) patients had 100-200 ml decrease in tumor volume. Intermediate risk histology 40 (75%) was most prevalent. During surgery, 35 (66%) children had no complications .Thirty-nine (73.5%) patients were cured, 4 (7.5%) patients were expired and 5 (9.4%) got left against medical advice (LAMA).

Conclusion: Our study infers that pre-operative chemotherapy reduces the tumor volume remarkably in WT making resection feasible