Vai trò của chụp cắt lớp vi tính trong điều trị bướu nguyên bào thận ở trẻ em với hóa trị tân bổ trợ

Nephroblastoma, commonly known as Wilms' tumor, constitutes a significant proportion of pediatric renal malignancies, with improved 5-year survival rates attributed to multimodal therapeutic approaches. Among these, the neoadjuvant chemotherapy protocol, particularly favored for larger or invasive tumors, aims to reduce tumor size and invasiveness before nephrectomy. Within this context, the accurate assessment of tumor characteristics, staging, and response to chemotherapy is paramount for optimizing surgical outcomes and overall patient prognosis. This study aims to evaluate the critical role of computed tomography (CT) in the diagnosis and management of nephroblastoma in children undergoing neoadjuvant chemotherapy at Children's Hospital 2, highlighting its contribution to treatment planning and patient care.

Pediatric oncologists, radiologists, pediatric surgeons, and medical researchers involved in the diagnosis and treatment of childhood cancers.

This cross-sectional study investigated the value of computed tomography (CT) in the treatment of pediatric nephroblastoma with neoadjuvant chemotherapy at Children's Hospital 2, analyzing data from 75 cases between April 2013 and June 2016. The research confirmed CT's high diagnostic accuracy, with an 85.3% consistency between CT findings and pathological results for nephroblastoma. The study revealed significant positive impacts of neoadjuvant chemotherapy as assessed by pre- and post-chemotherapy CT scans. Specifically, invasive perinephric fat tumors decreased from 85.9% to 43.8%, vascular invasion reduced from 20.3% to 6.3%, and regional lymph node metastasis dropped from 20.3% to 4.7%. Remarkably, all distant metastatic lesions disappeared. Furthermore, tumor volume substantially decreased from 487.9 cm³ to 206.8 cm³. The disease stage also regressed, with a notable increase in Stage I cases (0% to 56.3%) and reductions in more advanced stages (II, III, and IV). The overall response rate to chemotherapy was an impressive 89.1%. These findings underscore that computed tomography plays an essential role in monitoring tumor changes, staging, and assessing treatment response, thereby facilitating safer surgical interventions with fewer complications. The effective use of CT, especially with neoadjuvant chemotherapy, helps guide surgeons and improves patient outcomes by enabling precise surgical planning and potentially reducing the need for more aggressive subsequent therapies.