Nephroblastoma is the most common kidney tumor in children. The peak incidence is between 2 and 5 years old. Usually, the lesion affects one kidney, although there are reported cases of a bilateral disease. It is characterized by a high degree of malignancy; in about 10% cases, it is detected with metastases. The treatment of nephroblastomas uses surgical, radiation and medical methods.
Treatment Stages
In most cases, the treatment is initiated with preoperative chemotherapy. Administration of cytotoxic agents allows reducing the tumor size and facilitating the surgical procedures. In the early stages, a combination of vincristine and dactinomycin is used. In the presence of metastases, doxorubicin is also prescribed. The drug treatment takes 4 to 6 weeks.
The surgical procedure scope is determined by nephroblastoma size. Sometimes, chemotherapy allows reducing the tumor mass so that the organ-preserving surgery becomes possible. The surgeon removes a part of the kidney affected by cancer only. After a few years, thanks to the ability to regenerate, the preserved organ is restored to normal size.
Upon significant lesions, the kidney is removed entirely, together with the adrenal gland, when required. During surgery, the physician carefully examines the liver, adjacent lymph nodes and peritoneum for the presence of metastases. The suspicious tissue is also excised or biopsied.
Upon bilateral disease, the oncologist develops an individual treatment strategy, which will allow maintaining the functions of at least one kidney.
After surgery, the repeated chemotherapy is prescribed to destroy the residual tumor. Depending on the disease stage, a combination of 2 or 3 cytotoxic drugs with different mechanisms of action is administered again. The treatment duration can range from 1 to 8 months.
Some patients are also prescribed the radiation therapy (e.g., in the presence of metastasis or incomplete tumor removal). In childhood, a proton therapy is preferred, which allows a focused influence on the pathological focus without compromising the healthy tissues.
The operated area and lung metastases, when required, are subjected to irradiation. The procedures are carried out on an outpatient basis every day, from Monday to Friday. One session takes 15 to 20 minutes. The treatment course can take 1 to 6 weeks.
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