Evaluation of treatment outcomes for wilms tumor in children of Viet Nam using a chemotherapy-surgery strategy: Research in a low- and mid-income country

Background Wilm's tumor is a malignant renal neoplasm that primarily affects children and accounts for approximately 80–90% of pediatric renal cancers. The standard treatment protocols, NWTS-5 and SIOP-2001, report five-year survival rates greater than 90%. Objective This study evaluated the effectiveness and safety of a chemotherapy-first approach followed by surgical resection in treating children with stage II-IV Wilm's tumors. Methods A prospective cohort study was conducted on 64 pediatric patients treated at Children's Hospital No. 2, Ho Chi Minh City, from April 2013 to June 2019. Tumor volume was calculated using the ellipsoid formula, and radiologic response was assessed by RECIST 1.1. Kaplan estimated event-free survival (EFS), and predictors were evaluated by Cox regression. Results The median age at diagnosis was 23.8 months, with a male-to-female ratio of 1.2:1. Children with imaging-defined risk features at presentation were II-type (78.1%), III-type (18.8%), and IV-type (3.1%). Preoperative chemotherapy significantly increased tumor necrosis from 4.7% to 100% and reduced tumor volume from 487.9cm³ to 206.8cm³ (p < 0.001). Preoperative chemotherapy resulted in significant tumor necrosis and reduced tumor volume. Surgical complications were minimal, with an incidence of tumor rupture during surgery of 1.6%. Chemotherapy-related toxicities were manageable, with leukopenia (26.6%) and mucositis (35.9%) being the most common. The 4-year event-free survival (EFS) rate was 92.2%, with a recurrence rate of 7.8%. Factors influencing outcomes included tumor stage, vascular invasion, and the histological response to chemotherapy. Conclusion The chemotherapy-surgery strategy showed promising results, with high survival rates and low recurrence rates. This approach is recommended for pediatric oncology centers, especially in resource-limited settings.