Long term outcome in Wilms' Tumor.

Gomathi, - (2009) Long term outcome in Wilms' Tumor. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Nephroblastoma, or Wilms’ tumor, is an embryonal tumor that develops from remnants of immature kidney. It is the most common renal tumour of childhood. NWTS-5 protocol - Stage I : The tumor is limited to the kidney and was completely excised. The renal capsule has an intact outer surface. The tumor was not ruptured or biopsied prior to removal (fine-needle aspiration biopsies are excluded from this restriction). The vessels of the renal sinus are not involved. There is no evidence of tumor at or beyond the margins of resection. Stage II : The tumor extends beyond the kidney, but was completely excised. There may be regional extension of tumor (i.e. penetration of the renal capsule or extensive invasion of the renal sinus). The blood vessels outside the renal parenchyma, including those of the renal sinus, may contain tumor. The tumor was biopsied (except for fine-needle aspiration), or there was spillage of tumor before or during surgery that is confined to the flank, and does not involve the peritoneal surface. There must be no evidence of tumor at or beyond the margins of resection. Stage III : Residual non-hematogenous tumor is present, and confined to the abdomen. Any one of the following may occur: (1) Lymph nodes within the abdomen or pelvis are found to be involved by tumor (renal hilar, para-aortic, or beyond). (Lymph node involvement in the thorax, or other extra-abdominal sites would be a criterion for stage IV.) (2) The tumor has penetrated through the peritoneal surface. (3) Tumor implants are found on the peritoneal surface. (4) Gross or microscopic tumor remains postoperatively (e.g. tumor cells are found at the margin of surgical resection on microscopic examination). (5) The tumor is not completely resectable because of local infiltration into vital structures. (6) Tumor spill not confined to the flank occurred either before or during surgery. Stage IV : Hematogenous metastases (lung, liver, bone, brain, etc.), or lymph node metastases outside the abdominopelvic region are present. Stage V : Bilateral renal involvement is present at diagnosis. An attempt should be made to stage each side according to the above criteria on the basis of the extent of disease prior to biopsy or treatment. AIM : Our aim is to study the long term outcome in 156 children with Wilms’ tumor from december1999 - december 2009 in ICH . To analyze long term outcome in wilms tumour in perplex situations as double moiety, wilms with atrial thrombi, wilms in syndromic variety & bilateral Wilms’, wilms in horseshoe kidney and extrarenal wilms Our long term follow-up included time of menarche, skeletal growth, hyper tension , cardio toxicity due to usage of adriamycin & effects of radiotherapy. To analyze the time of resolution of IVC thrombus and effect of neo adjuvant therapy in horseshoe kidney, solitary kidney, bilateral wilms tumour, large tumour ,distant metastasis. MATERIALS AND METHODS : It is a combined prospective and retrospective study which pediatric urology OPD at the Institute of Child Health and Hospital for Children, Madras Medical College, Chennai. The study included patients with wilms, who attended the pediatric surgery during the ten years period, from Jan 1, 2000 to Dec 31, 2009. Selection Criteria : All patients with renal mass, hematuria, fever, abdominal pain. Inclusion Criteria : All patients with wilms tumour were proven radiologically, sonographically and HPE wise. Exclusion Criteria : stromal tumours as clear cell sarcoma, congenital mesonephric hamartoma, - rhabdoid tumour., angiomyolipoma of the kidney. The patients were subjected to detailed clinical examination and relevant investigations were performed, namely, ultrasound examination, IVU, +/- CECT.The treatment modalities were studied and patients were followed up to screen for residual lesion size, recurrences and liver and lung secondaries. CONCLUSION : Stage I &II have good prognosis. Stage III & IV needs close surveillance since they have high rate of recurrence. Recurrent tumors are not amenable to salvage chemotherapy. Stage V have bad prognosis. Stage IV wilms need lung irradiation. Neoadjuvant chemotherapy reduces tumor spillage in stage III &IV. Survival is poor in patients with wilms tumor and coexisting renal anomalies like horse shoe kidney.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Wilms' Tumor ; Long term outcome.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 03:00
Last Modified: 28 Jul 2017 03:00
URI: http://repository-tnmgrmu.ac.in/id/eprint/2289

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