Tek Taraflı Wilms Tümörü Olgularının Geriye Dönük Olarak Değerlendirilmesi
İdil Rana ,User
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Wilms tumor is the most common renal malignancy of childhood. Therefore, we designed a clinical study to review the treatment outcomes and the factors affecting survival of these patients. We identified demographic features, mode of presentation, applied treatments (chemotherapy, radiotherapy, surgery) and long term outcomes of 88 patients treated between 1990-2011 at our instution according to Turkish Pediatric Oncology Group protocol. Chi-square test, Mann-Whitney U test and Kaplan Meier survival analysis are used for statistical analysis. Our study included 50 females and 38 males and mean age at presentation is 3±2.48 years. Patients are grouped as stage 1 (n=35, 39.8%), stage 2a and 2b (n=16, 18.2%), stage 3 (n=17, 19.3%) and stage 4 (n=20, 22.7%). Pathologic examination of tumors revealed favorable histology in 76 patients (86.4%) and unfavorable histology in 10 patients (11.4%). Forty nine patients (55.6%) received preoperative chemotherapy and patient’s age at diagnosis, tumor trombus (6 patients) and the physical examination findings influence the decision of administrating preoperative chemotherapy (p<0.05). Under 1 year of age 25% of patients and 75% of patients between 3-5 years old received preoperative chemotherapy. The palpated mass crosses the midline in 20.5% of patients who were subjected to primary surgery. Treatment outcomes are as follows: 65 (73.9%) children are cured, 12 (13.6%) children died due to recurrences and metastasis, 4 (4.5%) children are under treatment and 7 (8%) children are lost to follow up. For stage 1 and 2 patients 100% survival rates are achieved, however survival decreased to 75% and 44.5% for stage 3 and 4 patients respectively. In conclusion, Wilms tumor patients are treated with low complication and high survival rates comparable to developed countries due to multidisciplinary treatment approach at our institution.