Clinical efficacy and prognosis with advanced Wilms' tumor in children / 中华实用儿科临床杂志

ABSTRACT

Objective To analyze the clinical data of 12 children with advanced Wlims' tumor in children from Feb.2009 to Jun.2012.All cases were diagnosed by pathology and to analysis the clinic efficacy and treatment experience were analyzed.Methods Of 12 patients,10 cases were male and 2 cases were female.The medium age of 12 patients was 2.54 years old(9 months-15 years old).According to pathological stage and clinical stage of The National Wilms' Tumor Study Group(NWTSG),5 cases belonged to stage lⅢ,and 7 cases stage Ⅳ.Six cases were well-differentiated tissue type,and 6 cases were poorly differentiated tissue type according to NWTSG.In all patients,different ways of chemotherapy and radiotherapy were selected according to clinical stage and tissue type differentiation.If a patient had repeated recurrence after common surgery and chemotherapy,would treated by antologous peripheral blood stem cell transplantation(APBSCT).Statistic analysis was used to analyze the clinical characters and efficacy and prognosis for 12 patients.Results 1.Initial symptomsin 12 cases,8 cases presented abdominal mass (66.6％),2 cases with abdominal pain and fever(12.7％),and 2 cases with hematuria(12.7％).2.Eleven cases followed up to Jan.2013,the medium time was 31.5 months(8-131 months).Of 12 cases,1 case give up therapy and follow-up and 11 cases were followed up.Of those 11 cases followed-up,4 cases had complete remission(CR),and 1 case had remission in part(PR),the conditions of 5 cases were progressively worse,1 case replapsed,and 4 patients died.Total survival rate was 63.63％ (7/11 cases),and mortality was 36.37％ (4/11 cases),and free survival rate was 36.37％ (4/11 cases),of that,1 patient of stage Ⅳ,relapsed 3 times after common radiotherapy and chemotherapy,achieved complete remission after high dose chemotherapy (Melphalan + Carboplatin + Etoposide,CEM) and APBSCT.The estimated 3-yearsurvival rate was 51.4％.Conclusions The prognosis of advanced Wilms' tumor is poor,and the mortality is still high.High dose chemotherapy with APBSCT may be a valuable method for advanced cases.