The correct name for this disease should be: adrenal neuroblastoma, which occurs in children and mainly originates from the adrenal gland.
Treatment
Nephroblastoma is one of the earliest and best solid tumors treated with a combination of surgery, radiation therapy and chemotherapy.
1.Surgery: Surgery is the indisputable first treatment option to remove the tumor. As long as the condition allows, the primary foci and even metastases should be removed as much as possible.
2.Radiotherapy: Nephroblastoma is very sensitive to radiotherapy. The common dose is 1.5-2.0Gy/d, 5 times/week, and the total dose is adjusted according to the age (30-35Gy).
3, chemotherapy: commonly used drugs are vincristine (vcr), actinomycin D (ACTD) and doxorubicin (ADR). The duration of treatment is 6-15 months.
Nephroblastoma is one of the earliest and best solid tumors to apply a combination of surgical, radiotherapy and chemotherapy measures. Comprehensive treatment of nephroblastoma is the key to improve survival, and multidisciplinary collaborative treatment is the most effective model of comprehensive treatment, and NWTS specifies that the surgeon’s tasks in this model are to
1. To perform surgical resection or biopsy of the tumor to establish the diagnosis.
2.Establish the tumor stage by evaluating the liver, lymph nodes and contralateral kidney.
3. Avoid tumor rupture and reduce postoperative radiotherapy.
For inoperable (the patient’s systemic condition cannot tolerate radical surgery) and unresectable (the tumor is too large or desirable to cause damage and cannot be removed by surgery) and highly staged nephroblastoma, this model allows for a substantial increase in the feasibility of surgery and the survival rate of comprehensive treatment. The details are as follows.
1.Surgical treatment
Transabdominal surgery is performed to examine the contralateral kidney and liver, and biopsies must be taken if there is a suspicious tumor. The tumor tissues with blood flow disorders are soft and brittle, easy to break, so the operation should be gentle to avoid the tumor being crushed (intraoperative tumor breakage and local recurrence chances are twice as much as those without breakage.) NWTS proposes that removal of the renal tip or lymph nodes adjacent to the aorta and vena cava does not change the prognosis, but careful examination and selection of lymph node biopsy are useful for tumor staging. If there is a tumor thrombus in the renal vein, the tumor thrombus must be removed by incision and then the renal tip must be ligated, which does not mean that the prognosis is poor. This does not mean that the prognosis is poor. Extra care must be taken when dealing with the renal hilum in large tumors to avoid accidental injury to important blood vessels. If the tumor invades the mesenteric root, duodenum and head of pancreas, it will be very risky if the tumor is still to be removed completely, then silver clips should be put on the suspected tumor remnant site to mark it.
2.Radiation therapy
Nephroblastoma is sensitive to radiotherapy, and in recent years, due to the use of chemotherapy, on many occasions, radiotherapy can be dispensed with. the amount of radiotherapy for high-risk patients with nephroblastoma by NWTS-3.
Age (months) Total amount of radiotherapy (CGY)
Birth～12 1,200～1,800
13～18 1,801～2,400
19～30 2,401～3,000
31～40 3,001～3,500
＞40 3,501～4,000