title: Efficacy of Different Protocols in Treatment of Nephroblastoma: A revisit.
abstract: BACKGROUND
  Management of Nephroblastoma (NB) remains a subject of debate despite the fact that it ranked first among primary childhood's renal neoplasm. We have previously discussed this issue 13, 14, yet, the sample size was limited.
  
  
  OBJECTIVE
  The aim of this study was to further evaluate the efficacy of initial surgery in the treatment of stage II and III pediatric NB as a part of the short administration schedule as in National Wilms' Tumor Study (NWTS)-4 and to evaluate its effectiveness compared to the long administration schedule.
  
  
  METHODS
  The study included 50 children who were primarily diagnosed as stage II and III NB. They were divided into 2 equal groups. Group I (n = 25) included children who have undergone neoadjuvant chemotherapy followed by surgery and postoperative chemotherapy, while group II (n = 25) included children who have undergone primary surgery as an initial management followed by chemotherapy. After a mean postoperative follow-up period of 20±6 months, clinical and radiological evaluation was performed to all patients.
  
  
  RESULTS
  In group I, 15 patients were preoperatively diagnosed as stage II and 10 patients as stage III while in group II, 16 patients were proved to be stage II and 9 patients were stage III. After a follow up period, clinical and radiological evaluation using CT was performed to all patients. In patients with stage II, evidence of recurrence was noted in 5 patients of group I whereas no patient showed any evidence of recurrence in group II. In patients with stage III, rebound increase in size was seen in 3 patients in group I and only one patient in group II.
  
  
  CONCLUSIONS
  This study confirmed our previous conclusions that initial surgical intervention with appropriate adjuvant therapy has a better outcome than the neoadjuvant chemotherapy and delayed surgery for children primarily diagnosed as stage II and III NB. Moreover, it may also act as a short administration schedule for the treatment as it is not less effective than the long administration schedule and can be administered at a substantially lower total treatment cost.
authors.affiliation: Department of Surgery, College of Medicine, King Faisal University, Al Ahsa, KSA.|Department of Surgery, Faculty of Medicine, Suez Canal University, Egypt.
authors.forename: O M
authors.initials: OM
authors.lastname: Zakaria
authors.affiliation: Department of Surgery, College of Medicine, King Faisal University, Al Ahsa, KSA.
authors.forename: M Y I
authors.initials: MY
authors.lastname: Daoud
authors.affiliation: Department of Surgery, Faculty of Medicine, Suez Canal University, Egypt.
authors.forename: S H
authors.initials: SH
authors.lastname: Farrag
authors.affiliation: Department of Surgery, College of Medicine, King Faisal University, Al Ahsa, KSA.
authors.forename: A S
authors.initials: AS
authors.lastname: Mulhim
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000628:therapy*; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000628:therapy*
keywords: Chemotherapy and Surgery.; Children; NWTSG4; Nephroblastoma; SIOP