29. ROLE OF COMPUTED TOMOGRAPHY IN THE TREATMENT OF NEPHROBLASTOMA IN CHILDREN WITH NEOADJUVANT CHEMOTHERAPY

Vu Truong Nhan

Main Article Content

Abstract

Objective: To evaluate the value of computed tomography in the treatment of nephroblastoma in children with neoadjuvant chemotherapy at Children's Hospital 2.


Methods: Cross sectional study.


Results: From April 2013 to June 2016, there were 75 cases were diagnosed as nephroblastoma on computed tomography and treated with neoadjuvant chemotherapy. The rate of confirmed diagnosis of nephroblastoma on computed tomographic appearances consistent with pathological results was 85.3%. Pre- and post-chemotherapy computed tomography appearances are valuable in assessing the impact of chemotherapy on nephroblastoma: The rate of invasive perinephric fat tumors decreased from 85.9% to 43.8%. The rate of vascular invasive tumors decreased from 20.3% to 6.3%. The rate of regional lymph node metastasis decreased from 20.3% to 4.7%. The distant metastatic lesions all disappeared. The tumor volume reduced from 487.9 cm3 to 206.8 cm3. The percentage increased from 0% to 56.3% in stage I disease; decreased from 78.1% to 37.5% in stage II disease; decreased from 18.8% to 6.3% stage III disease; and decreased from 3.1% to 0% in stage IV disease. The overall response rate was 89.1%.


Conclusions: Computed tomography plays an important role in the treatment of nephroblastoma according to neoadjuvant chemotherapy regimen, helping to assess changes in tumor characteristics, stage, volume, and chemotherapy response when performing nephrectomy after chemotherapy, creating favorable conditions for surgeons to orient safer surgery with fewer complications.

Article Details

References

[1] Chiou SS. Malignant renal tumors in childhood. Pediatr Neonatol. 2014;55(3):159-160.
[2] Weirich A, Ludwig R, Graf N, et al. Survival in nephroblastoma treated according to the trial and study SIOP-9/GPOH with respect to relapse and morbidity. Ann Oncol. 2004;15(5):808-820.
[3] Powis M, Messahel B, Hobson R, et al. Surgical complications after immediate nephrectomy versus preoperative chemotherapy in non-metastatic Wilms' tumour: findings from the 1991-2001 United Kingdom Children's Cancer Study Group UKW3 Trial. J Pediatr Surg. 2013;48(11):2181-2186.
[4] Servaes SE, Hoffer FA, Smith EA, et al. Imaging of Wilms tumor: an update. Pediatr Radiol. 2019;49(11):1441-1452.
[5] Đặng Hữu Chiến. Đánh giá giai đoạn và nhóm nguy cơ theo SIOP 2001 liên quan thời gian sống còn toàn bộ trong điều trị u Wilms ở trẻ em, Luận văn Bác sĩ chuyên khoa II, Đại học Y Dược TP. Hồ Chí Minh; 2018.
[6] SIOP. Nephroblastoma clinical trial and study _ SIOP WT 2001. UK Version 5; 2010.
[7] Kang H, Lee HY, Lee K, et al. Imaging-Based Tumor Treatment Response Evaluation: Review of Conventional, New, and Emerging Concepts. Korean journal of radiology : official journal of the Korean Radiological Society. 2012;13:371-390.
[8] Irtan S, Van Tinteren H, Graf N, et al. Evaluation of needle biopsy as a potential risk factor for local recurrence of Wilms tumour in the SIOP WT 2001 trial. Eur J Cancer. 2019;116:13-20.
[9] Stehr M, Deilmann K, Haas RJ, et al. Surgical complications in the treatment of Wilms' tumor. Eur J Pediatr Surg. 2005;15(6):414-419.
[10] Vujanic GM, D'Hooghe E, Popov SD, et al. The effect of preoperative chemotherapy on histological subtyping and staging of Wilms tumors: The United Kingdom Children's Cancer Study Group (UKCCSG) Wilms tumor trial 3 (UKW3) experience. Pediatr Blood Cancer. 2019;66(3):e27549.
[11] Trần Đức Hậu. U nguyên bào thận điều trị tại Bệnh viện Nhi Trung Ương theo phác đồ SIOP 2001. Tạp chí Nhi khoa. 2013;6(1):54-59.
[12] Elayadi M, Magdy S, Khalil E, et al. Management and outcome of pediatric metastatic Wilms' tumor at the National Cancer Institute, Egypt. J Egypt Natl Canc Inst. 2020;32(1):19.
[13] Xu S, Sun N, Zhang WP, et al. Management of Wilms tumor with intravenous thrombus in children: a single center experience. World J Pediatr. 2019;15(5):476-482.
[14] McMahon S, Carachi R. Wilms' tumor with intravascular extension: A review article. J Indian Assoc Pediatr Surg. 2014;19(4):195-200.
[15] Silva EJC, Silva GAP. Local behavior and lymph node metastases of Wilms’ tumor: accuracy of computed tomography. Radiol Bras. 2014;47(1):9-13.
[16] Dix DB, Seibel NL, Chi YY, et al. Treatment of Stage IV Favorable Histology Wilms Tumor With Lung Metastases: A Report From the Children's Oncology Group AREN0533 Study. J Clin Oncol. 2018;36(16):1564-1570.
[17] Debarpita D, Debashis D, Nupur B, et al. A comparative study of diagnostic performance of CT and MRI for abdominal staging of paediatric renal tumours-a report from tertiary care centre hospital. J Nephro & Endo Res. 2021;1(1):1-6.