Sandeep Agarwala¹, S. Mukherjee¹, V Jain¹, DK Yadav¹, A Dhua¹, S Bakhshi², A Biswas³, M Srinivas¹, P Goel¹, M Jana⁴, D Parthasarthy⁴
1- Department of Pediatric Surgery, AIIMS, New Delhi, India
2- Department of Medical Oncology, BRAIRCH, AIIMS, India
3- Department of Radiation Oncology, BRAIRCH, AIIMS, India
4- Department of Radiodiagnosis and Interventional Radiology, BRAIRCH, AIIMS, India
Abstract Body
Aim: To analyze the outcomes of stage III WT and determine factors affecting outcome.
Methods: Analysis of prospectively maintained data of Stage III WT treated from1999 to 2018 followed up for at least a period of 5 years. Staging was as per NWTS-5 and treatment was as per AIIMS-WT-99 protocol utilizing NACT for select patients. These patients were analyzed for recurrences, survival, spill, IVC thrombus, lymph node positivity , chemotherapy and radiotherapy . Kaplan-Meir analysis for 4-year overall survival(OS) and Event free survival (EFS) was done. Result: Out of 335 patients of WT treated in this period, 153(45%) were Stage-III. Age ranged 2-144 months and 97% had a favorable histology . These were Stage III because of capsular breach in 10(6.5%), Spill in 27(17 .6%), positive lymph node 13(8.4%), IVC-thrombus 19(12.4%). 12(7 .8%) were operated elsewhere hence intraoperative data was not available. 98% patients had undergone resection. 112(73%) received Neoadjuvant chemotherapy (NACT) and all adjuvant chemotherapy (ACT) and 84% received adjuvant radiotherapy (RT). Twelve patients died and 15 recurred giving a 4-year OS and EFS 92.4% and 85% respectively , with mean survival of 240 months (229-250 months). Forty-nine of 153 (32%) patients were labelled as Stage-III only because of receiving NACT. There were no recurrence in this group. The 4 year OS and EFS for this cohort of Stage-III patients was 95.7% and 95.7%.
Conclusion: Thirty-two percent patients were labelled as Stage-III only because of receiving NACT and the 4-year OS and EFS was better in this group. There were no recurrences in this group.