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"Neoadjuvant Chemotherapy"

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"Neoadjuvant Chemotherapy"

Original Article

[English]
Clinical Characteristics and Prognosis of Hepatoblastoma in Children
Min Young Kim, Dae Yeon Kim, Hyo Seop Ahn, Chong Jai Kim, In One Kim, Sung Eun Jung, Seong Cheol Lee, Kwi Won Park, Woo Ki Kim
J Korean Assoc Pediatr Surg 1997;3(2):133-142.   Published online December 31, 1997
DOI: https://doi.org/10.13029/jkaps.1997.3.2.133

Hepatoblastoma is a rare pediatric malignancy which frequently presents at an advanced unresectable stage. With the neoajuvant chemotherapy, improved resectability and survival have been reported. Twenty children with biopsy proven hepatoblastoma were treated during the period between January 1987 and June 1995. Median age at diagnosis was 13 months(2 months to 7 year and 10 months), and 13 were male. Histologic profile was 13 epithelia1(5 fetal, 4 mixed, 1 embryonal, 3 undetermined), and 5 mixed mesenchymal and epithelial and 2 of undetermined type. Chemotherapy effectively reduced the tumor volume(p=0.008), and' was able to convert 7 out of 9 initially unresectable cases(78%) to resectable ones. Twelve radical and 2 palliative operations were done with or without adjuvant chemotherapy. The Median follow up period was 33 months and the median survival was 26 months. The group with curative resection had a 61.1 % 5 year survival rate, but none of palliative resection grpup survived more than 13 months(p=0.000l). In univariate analysis for prognostic factors revealed, large tumor size at diagnosis and abscence of thrombocytopenia were associated with poor survival, but these differences were not statistically significant. Histological pure fetal type did not mean a better prognosis. Even with a recent neoadjuvant chemotherapy, the strategy should be focused on the radical resection as early as possible.

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Case Report

[English]
Approximately 5% of Wilms tumors are bilateral. Multidisciplinary care including surgery, chemotherapy, and radiation has greatly improved the survival rates. With long-term survivorship, treatment should be planned to ensure quality survival. Nephron-sparing surgery (NSS) is now a recommended alternative to bilateral nephrectomy with renal replacement therapy in bilateral Wilms tumors. However, the feasibility of bilateral NSS is dependent on multiple factors like the size, location of the tumor, and response to chemotherapy. In advanced bilateral tumors, a) prolonging preoperative chemotherapy to achieve optimum response for performing a salvageable renal surgery and b) administering chemotherapy in between the staged nephrectomies, is an effective strategy. Response assessment with imaging will help in a) selection of appropriate surgery, b) timing and c) sequencing of surgery. We present a patient with bilateral Wilms tumor managed with neoadjuvant chemotherapy followed by staged bilateral NSS followed by adjuvant chemotherapy at our institute. The patient is alive with a follow-up of 5 years.
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