Original Research Article
Year: 2018 | Month: November | Volume: 8 | Issue: 11 | Pages: 69-74
Comparison of SIOP and NWTSG Protocols in Clinico-Histological Spectrum of Childhood Renal Tumors – A Tertiary Center Experience
Dr Atin Singhai1, Dr Manu Kureel2, Dr Suresh Babu3, Dr Madhu Kumar1, Dr Mamta Dwivedi2, Dr Jiledar Rawat3
1Associate Professor, 2Resident, 3Professor
Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh, India
Corresponding Author: Dr Atin Singhai
ABSTRACT
International Society of Pediatric Oncology (SIOP) grading of childhood renal tumors receiving preoperative chemotherapy judiciously delineates subclasses and subgroups as per chemotherapy induced changes which guides clinicians for planning further course of management.
A total of 32 cases were enrolled in our study, of which 23 received preoperative / neoadjuvant chemotherapy while 9 underwent upfront nephrectomy. Of 23 neoadjuvant chemotherapy received cases, all were clinico-radiologically suspicious for nephroblastoma, however 4 had different histological diagnosis viz clear cell sarcoma of kidney (CCSK) in 2 and 1 each rhabdoid tumor and neuroblastoma. All 9 cases of upfront nephrectomy were histologically nephroblastoma and managed as per National Wilms Tumor Study Group (NWTSG) protocol. Among rest of the cases treated as per SIOP protocol, significant response of epithelial and stromal elements to chemotherapy as well as reduction in tumor size was noted. However, blastemal predominant and diffuse anaplastic variants as well as other high risk tumors like CCSK, rhabdoid tumor and neuroblastoma had nil or minimal response and had to be considered for further chemotherapy.
To conclude, management of childhood renal tumors especially nephroblastoma by SIOP protocol offers distinct advantage over NWTSG treated cases by efficient reduction in viable tumor load along with demarcation of high risk cases which require further chemotherapy.
Key words: Nephroblastoma, SIOP, NWTS, Neoadjuvant chemotherapy, Response