RESUMO
Background: Treatment options for Wilms' tumour [WT] are costly and it affects the country's health budget and resources if adopted and implemented at the national level especially in developing countries with low or resource-challenged settings
Aim: The objective of this study is to evaluate the role and effectiveness of primary surgery in the treatment of stage II and III pediatric WT following the schedule indicated in the National Wilms' Tumor Study [NWTS-4] in the institutes of two developing countries
Patients and Methods: The study enrolled 40 children who were primarily diagnosed as stage II and III WT. They were divided into 2 equal groups. Group I [n = 20] included those children who have undergone neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy, while group II [n = 20] included those children who have undergone primary surgery as an initial management followed by chemotherapy. After a mean postoperative follow-up period of 20+/-5 months, clinical and radiological evaluation was performed for all patients
Results: In group I, 15 patients were preoperatively diagnosed as stage II and 5 patients as stage III while in group II, 16 patients were proved to be stage II and 4 patients were stage III. After a follow up period, clinical and radiological evaluation using CT was performed on all patients. In patients with stage II, evidence of recurrence was noted in 4 patients of group I whereas no patient showed any evidence of recurrence in group II. In patients with stage III, rebound increase in size was seen in 2 patients in group I and only one patient in group II
Conclusion: Primary surgery with appropriate adjuvant therapy improves the treatment results compared to the neoadjuvant chemotherapy and delayed surgery for children primarily diagnosed as stage II and III WT. It may be used as a safe and effective tool in treating WT patients with relatively no changes from the long administration schedules. This will have a highly positive impact in lowering treatment cost in developing countries