Abstract:

Objective To investigate the therapeutic effects of individualized comprehensive treatment for Wilms tumor in children. Methods The clinical data of patients with Wilms tumor confirmed by clinical features, radiology and pathology from September 2005 to December 2009 were collected. Thirty-eight patients were included, with 24 males and 14 females, and the mean age was 2.67 years. There were unilateral lesions in 37 cases and bilateral lesions in 1 case. Individualized comprehensive treatment regimen was designed. Tumorectomy and nephrectomy were optimal approaches for unilateral lesions. For those with high risks for operation, chemotherapy was performed after fine needle aspiration biopsy to constrict the masses and eliminate the metastatic lesions, and operations were followed. Chemotherapy and chemotherapy combined with radiotherapy were designed after operation according to the histological types and clinical stages of tumors. Patients were followed up for 12 to 60 months. Results The total remission rate was 97.37% (37/38), the overall survival was 89.47% (34/38), and the disease-free survival was 86.84% （33/38）. The disease-free survival of patients with clinical stage Ⅰ and stage Ⅱ were 100% （17/17）and 91.67% （11/12）respectively, which were significantly higher than those of patients with clinical stage Ⅲ (60.00%, 3/5) and stage Ⅳ (66.67%, 2/3)（P<0.01）. The overall survival was 96.77％ (30/31) in patients with favorable histological types, that was 57.14％ (4/7) in patients with unfavorable histological types, and there were significant differences between them (P=0.001). Five patients experienced recurrence (13.16%), 3 of whom were rhabdomyosarcoma type. Conclusion Individualized comprehensive treatment may yield good therapeutic effects for Wilms tumor in children. Patients of unfavorable histological types (rhabdomyosarcoma type for example) and advanced stages (clinical stage III and stage IV) may have worse prognosis, and should be attached greater importance.

Key words: Wilms tumor, comprehensive treatment, children