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Fang Y, Li Z, Song H, Zhang W, Li N, Yang Y. Does bilateral Wilms' tumor involving the collecting system in children have a worse prognosis? BMC Urol 2024; 24:141. [PMID: 38977987 PMCID: PMC11229180 DOI: 10.1186/s12894-024-01525-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 06/27/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The literature on nephron-sparing surgery (NSS) in children with bilateral Wilms' tumors (BWT) involving the collection system is mostly comprised of case reports. The present study aimed to summarize the clinical characteristics, treatments, and prognosis of children with BWT involving the collecting system admitted to our pediatric surgery center compared with those whose tumors did not involve the collecting system. A secondary aim was to discuss how to preserve more kidney parenchyma and prevent long-term renal failure under the premise of preventing tumor recurrence. METHODS Patients with BWT admitted to our pediatric surgery center between January 2008 and June 2022 were reviewed. All included patients were grouped according to the relationship between the tumor and collecting system according to the intraoperative findings. Group I included children with tumor infiltrating the collecting system, group II included children with tumor growing into the collecting system, and group III included children whose tumor did not involve the collecting system. The clinical features, treatments and prognosis of the patients were analyzed. RESULTS Seventy patients were enrolled, including 20 patients with 25 sides of tumors infiltrating the collecting system in group I,10 patients with 13 sides of tumors growing into the collecting system in group II, and 40 patients in group III. There was no significant difference in patients age and gender between group I and group II. In total, 20 patients in group I and 9 patients in group II had partial response (PR) after neoadjuvant chemotherapy. In group I, 22 of 25 sides of tumors underwent NSS; in group II, 11 of 13 sides of tumors underwent NSS. During an average follow-up of 47 months, in group I, 6/20 patients relapsed and 2/20 patients died; in group II, 3/10 patients relapsed and 1/10 patient died. There was no significant difference in 4-year overall survival (OS) rate among groups I, II and III (86.36% vs. 85.71%vs. 91.40%, P = 0.902). CONCLUSIONS To preserve renal parenchyma, NSS is feasible for children with BWT involving the collecting system. There was no significant difference in postoperative long-term OS between patients with BWT involving the collecting system and not involving the collecting system.
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Affiliation(s)
- YiWei Fang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - ZhenWu Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China.
| | - HongCheng Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China.
| | - WeiPing Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Ning Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - Yang Yang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
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Banerjee A, Babu R, Jayaraman D, Chilukuri S. Preoperative three-dimensional modelling and virtual reality planning aids nephron sparing surgery in a child with bilateral Wilms tumour. BMJ Case Rep 2024; 17:e260600. [PMID: 38642931 PMCID: PMC11033631 DOI: 10.1136/bcr-2024-260600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Abstract
Bilateral Wilms tumour (BWT) is a surgically challenging condition. Virtual reality (VR) reconstruction aids surgeons to foresee the anatomy ahead of Nephron Sparing Surgery (NSS). Three-dimensional (3D) visualisation improves the anatomical orientation of surgeons performing NSS. We herewith report a case of BWT where VR planning and 3D printing were used to aid NSS. Conventional imaging is often found to be inadequate while assessing the tumour-organ-vascular anatomy. Advances like VR and 3D printing help surgeons plan better for complex surgeries like bilateral NSS. Next-generation extended reality tools will likely aid robotic-assisted precision NSS and improve patient outcomes.
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Affiliation(s)
- Avijit Banerjee
- Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Ramesh Babu
- Pediatric Urology, Sri Ramachandra University Medical College, Chennai, India
| | - Dhaarani Jayaraman
- Paediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, India
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de Souza FKM, Fanelli MCA, Duarte AAB, Alves MTDS, Lederman HM, Cypriano MDS, Abib SDCV. Surgery in Bilateral Wilms Tumor-A Single-Center Experience. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1790. [PMID: 38002881 PMCID: PMC10670692 DOI: 10.3390/children10111790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Abstract
The treatment of bilateral Wilms tumors (BWT) involves curing the cancer, preserving long-term renal function, and maintaining a good quality of life. Established methods for achieving these goals include preoperative chemotherapy and nephron-sparing surgery (NSS). This study aimed to evaluate the experience of a single institution in treating patients with BWT. We analyzed cases of BWT treated at the Pediatric Oncology Institute-GRAACC-Federal University of São Paulo over a period of 35 years. Bleeding control was performed with manual compression of the renal parenchyma. Thirty-three patients were included in the study. Thirty cases were synchronous tumors. The mean age at diagnosis was 30.4 months (±22 m) and 66.7% were girls. The median follow-up period was 83 months. Neoadjuvant chemotherapy was the primary approach in most patients (87.9%), with a simultaneous upfront surgical approach performed in 84.8%. Most patients underwent bilateral NSS (70.4%). There were no early complications in this series, but 39.4% had clinical complications. The five-year survival rate was 76%. Therefore, it is clear that the surgical approach to BWT plays a crucial role in achieving good outcomes. However, it is difficult to standardize surgical techniques and technology may have the potential to enhance safety.
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Affiliation(s)
- Fernanda Kelly Marques de Souza
- Department of Pediatric Surgery, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil; (M.C.A.F.); (A.A.B.D.); (S.d.C.V.A.)
| | - Mayara Caroline Amorim Fanelli
- Department of Pediatric Surgery, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil; (M.C.A.F.); (A.A.B.D.); (S.d.C.V.A.)
| | - Alexandre Alberto Barros Duarte
- Department of Pediatric Surgery, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil; (M.C.A.F.); (A.A.B.D.); (S.d.C.V.A.)
- Department of Pediatric Surgery, Foundation Regional Faculty of Medicine of São José do Rio Preto, Children’s and Maternity Hospital, São José do Rio Preto 15091-240, Brazil
| | | | - Henrique Manoel Lederman
- Department of Radiology, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil;
| | - Monica dos Santos Cypriano
- Department of Pediatric Oncology, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil;
| | - Simone de Campos Vieira Abib
- Department of Pediatric Surgery, Pediatric Oncology Institute, GRAACC, Federal University of São Paulo, São Paulo 04039-001, Brazil; (M.C.A.F.); (A.A.B.D.); (S.d.C.V.A.)
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Chen SY, Lee WG, Laifman E, Mack SJ, Zhou S, Kim ES. A Single Center Experience With Bilateral Wilms Tumor. Am Surg 2023; 89:4101-4104. [PMID: 37208897 PMCID: PMC10756228 DOI: 10.1177/00031348231175446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND Wilms tumor (WT) is the most common pediatric renal malignancy and bilateral disease (BWT) occurs in 5% of cases and is associated with poor outcomes. Management of BWT includes chemotherapy and oncologic resection while preserving renal function. Previous literature has demonstrated variable approaches in BWT treatment. The aim of this study was to examine a single institution experience and outcomes with BWT. METHODS A retrospective chart review was performed for all patients with WT treated at a free-standing tertiary children's hospital between 1998 and 2018. Patients with BWT were identified and treatment courses were compared. Outcomes of interest included need for dialysis post-operatively, need for renal transplantation post-operatively, disease recurrence, and overall survival. RESULTS Of 120 children with WT, 9 children (6F:3M) of median age 32 months (IQR: 24-50 months) and median weight 13.7 kg (IQR: 10.9-16.2 kg) were diagnosed with and treated for BWT. Pre-operative biopsies were obtained in 4/9 patients, 3 of whom received neoadjuvant chemotherapy and 1 who underwent radical nephrectomy. Of the 5 patients who did not undergo biopsy, 4/5 were treated with neoadjuvant chemotherapy, and 1/5 underwent upfront nephrectomy. Post-operatively, 4/9 children required dialysis, of whom 2 subsequently underwent renal transplantation. Two patients were lost to follow-up, and of the remaining 7 patients, disease recurrence occurred in 5/7 children and overall survival was 71% (n=5). CONCLUSION Management of BWT varies regarding the use of pre-operative biopsy, neoadjuvant chemotherapy, and extent of disease resection. Further guidelines on treatment protocols may optimize outcomes in children with BWT.
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Affiliation(s)
- Stephanie Y. Chen
- Division of Pediatric Surgcery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - William G.H. Lee
- Division of Pediatric Surgcery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric Laifman
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Shale J. Mack
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Shengmei Zhou
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Clinical Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eugene S. Kim
- Division of Pediatric Surgcery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Fang Y, Li Z, Song H, Sun N, Zhang W. Treatment of bilateral Wilms' tumor in children: how to improve the application of nephron-sparing surgery. Pediatr Surg Int 2023; 39:145. [PMID: 36856873 DOI: 10.1007/s00383-023-05433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE To summarize the experience of nephron-sparing surgery (NSS) for bilateral Wilms tumors (BWT) in children. METHODS This study included children with BWT admitted to our hospital between January 2008 and June 2022. The details of the treatments and outcomes were analyzed. RESULTS In all, 70 patients (39 males and 31 females) were enrolled, including 66 patients with synchronous tumors and 4 patients with metachronous tumors. The median age at diagnosis was 13 (3-75) months. Overall, 59 patients received preoperative chemotherapy and 45.8% (54/118) of the 118 sides of WT achieved a partial response (PR). Of the 70 patients, 48 (68.6%) underwent bilateral NSS and 22 (31.4%) underwent unilateral NSS and contralateral total nephrectomy. The proportion of bilateral NSS in the preoperative chemotherapy group was significantly higher than in the non-chemotherapy group (P = 0.031). Additionally, there were 26, 25, 14, and 5 cases of stage I, stage II, stage III, and stage IV, respectively. Among the 70 children, 16 had a recurrence, and 8 died. The 4 years EFS and OS were 67.9% and 89.3%, respectively. CONCLUSIONS The long-term survival rates of patients with BWT improved. Hence, preoperative chemotherapy should be administered to enhance the use of NSS in BWT.
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Affiliation(s)
- YiWei Fang
- Department of Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - ZhenWu Li
- Department of Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
| | - HongCheng Song
- Department of Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China.
| | - Ning Sun
- Department of Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China.
| | - WeiPing Zhang
- Department of Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56 Nanlishi St, Xicheng District, Beijing, 100045, China
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Meier CM, Furtwängler R, Mergen M, Welter N, Melchior P, Schenk JP, Vokuhl C, Kager L, Kroiss-Benninger S, Wagenpfeil S, Graf N. Impact of Time to Surgery on Outcome in Wilms Tumor Treated with Preoperative Chemotherapy. Cancers (Basel) 2023; 15:cancers15051494. [PMID: 36900286 PMCID: PMC10001069 DOI: 10.3390/cancers15051494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/05/2023] Open
Abstract
(1) Background: Wilms tumor (WT) treated preoperatively is cured in over 90% of cases. However, how long preoperative chemotherapy can be given is unknown. (2) Methods: 2561/3030 patients with WT (age < 18 years) treated between 1989 and 2022 according to SIOP-9/GPOH, SIOP-93-01/GPOH, and SIOP-2001/GPOH are retrospectively analyzed to assess the risk of time to surgery (TTS) for relapse-free survival (RFS) and overall survival (OS). (3) Results: TTS was calculated for all surgeries, with the mean being 39 days (38.5 ± 12.5) for unilateral tumors (UWT) and 70 days (69.9 ± 32.7) for bilateral disease (BWT). Relapse occurred in 347 patients, of which 63 (2.5%) were local, 199 (7.8%) were metastatic, and 85 (3.3%) were combined. Moreover, 184 patients (7.2%) died, 152 (5.9%) due to tumor progression. In UWT, recurrences and mortality are independent of TTS. For BWT without metastases at diagnosis, the incidence of recurrence is less than 18% up to 120 days and increases to 29% after 120 days, and to 60% after 150 days. The risk of relapse (Hazard Ratio) adjusted for age, local stage, and histological risk group increases to 2.87 after 120 days (CI 1.19-7.95, p = 0.022) and to 4.62 after 150 days (CI 1.17-18.26, p = 0.029). In metastatic BWT, no influence of TTS is detected. (4) Conclusions: The length of preoperative chemotherapy has no negative impact on RFS or OS in UWT. In BWT without metastatic disease, surgery should be performed before day 120, as the risk of recurrence increases significantly thereafter.
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Affiliation(s)
- Clemens-Magnus Meier
- Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, 66424 Homburg, Germany
- Correspondence: (C.-M.M.); (N.G.); Tel.: +49-(0)6841-16-22687 (C.-M.M.); +49-(0)6841-16-28411 (N.G.)
| | - Rhoikos Furtwängler
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center, 66424 Homburg, Germany
| | - Marvin Mergen
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center, 66424 Homburg, Germany
| | - Nils Welter
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center, 66424 Homburg, Germany
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Medical Center, 66424 Homburg, Germany
| | - Jens-Peter Schenk
- Pediatric Radiology Section, Department for Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Christian Vokuhl
- Institute of Pathology, University Hospital Bonn, 53127 Bonn, Germany
| | - Leo Kager
- St. Anna Children’s Hospital, Department of Pediatrics, Medical University Vienna, 1090 Vienna, Austria
- St. Anna Children’s Cancer Research Institute, 1090 Vienna, Austria
| | | | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Campus Homburg, 66424 Homburg, Germany
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center, 66424 Homburg, Germany
- Correspondence: (C.-M.M.); (N.G.); Tel.: +49-(0)6841-16-22687 (C.-M.M.); +49-(0)6841-16-28411 (N.G.)
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Zhong Z, Jiang H, Chen H, Wu C, Wang Y, Zhang Z, Li J, Liu J. Ex vivo tumor dissection followed by kidney autotransplantation in bilateral wilms tumor. Front Pediatr 2023; 11:1120797. [PMID: 36816368 PMCID: PMC9936068 DOI: 10.3389/fped.2023.1120797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Successful management of bilateral Wilm's tumor (BWT) involves a radical resection while preserving enough normal kidney tissue. Nephron-sparing surgery often results in an R1/R2 resection with a high recurrence rate in children with huge or multiple tumors, or tumors proximity to the renal hilum. In contrast, kidney autotransplantation can completely resect the tumor while maintaining homeostasis and preserving the patient's healthy kidney tissues. METHODS We summarized the clinical data of 8 synchronous BWT patients who underwent kidney autotransplantation at the First Affiliated Hospital of Sun Yat-sen University from 2018 to 2020. Ex vivo tumor resection and kidney autotransplantions were performed on 11 kidneys. The baseline characteristics, perioperative management, and survival status were reported. RESULTS Nephron-sparing surgeries were performed on 5 kidneys in vivo. Among all the 8 patients, six of them (75%) received staged operation and the other 2 patients (25%) received single-stage operation. No residual tumors were found on the postoperative imaging in all the 8 patients. In total, 6 (75%) patients occurred complications after the autotransplantation, among which, 2 (33.3%) patients had complication of Clavien-Dindo grade IIIa, and 4 (66.7%) patients had complication of grade < 3. During the 38 months of follow-up, 87.5% (7/8) of patients were tumor-free survival with normal renal function. One patient died from renal failure without tumor recurrence. DISCUSSION Therefore, our study indicated that autologous kidney transplantation can be an option for patients with complex BWT if the hospital's surgical technique and perioperative management conditions are feasible.
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Affiliation(s)
- Zhihai Zhong
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong Jiang
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huadong Chen
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Department of Organ Transplantation, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuanqi Wang
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhichong Zhang
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Department of Organ Transplantation, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Juncheng Liu
- Department of Pediatric Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Gao P, Li J, Chen H, Wu W, Liu L, Jiang H, Xu L, Wu C, Fu Q, Liu J, Wang C. Bench surgery with autotransplantation for bilateral Wilms tumor-A feasible technique for renal sinus invasion. Front Surg 2022; 9:1047975. [PMID: 36582965 PMCID: PMC9793901 DOI: 10.3389/fsurg.2022.1047975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose Bilateral Wilms tumor (BWT) with renal sinus invasion requires extremely difficult surgical care. This study presents an alternative strategy for tumor removal while at the same time preserving the renal parenchyma. Materials and methods In total, 9 cases of synchronous BWT were admitted to our hospital between May 2016 to Aug 2020. We retrospectively reviewed the clinical data, surgical technique, and functional and oncological outcomes of these cases. Results The 9 cases included 3 males and 6 females, with a median age of 12 months at surgery (range 7-40). A total of 14 kidney units had renal sinus invasion (77.8%), whereas multifocal neoplasms were observed in 7 units (38.9%). The local stage distribution revealed 1 kidney with stage I, 10 kidneys with stage II, and 7 kidneys with stage III. Nephron-sparing surgery was performed on 15 kidney units (83.3%), among which 13 (72.2%) underwent bench surgery with autotransplantation (BS-AT), whereas 2 (11.1%) were subjected to tumor enucleation in vivo. Urinary leakage was the most prevalent postoperative complication. We observed negative margins. During the mean follow-up of 28.4 months, 2 patients (22.2%) succumbed from sepsis and renal failure, respectively, whereas the other 7 (77.8%) survived without recurrence. Survivors experienced an estimated glomerular filtration rate of 81 ± 15.4 ml/(min × 1.73 m2). The endpoint renal volume of 9 renal units receiving BS-AT significantly increased (P = 0.02). Conclusions In summary, the surgical management of bilateral Wilms tumor requires meticulous operative approach and technique. Besides, BS-AT provides a viable alternative to nephron-sparing surgery for BWT patients with renal sinus invasion.
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Affiliation(s)
- Pengfei Gao
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huadong Chen
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenrui Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Longshan Liu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong Jiang
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lingling Xu
- Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chenglin Wu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Juncheng Liu
- Department of Pediatric Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,Correspondence: Juncheng Liu Changxi Wang
| | - Changxi Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China,Correspondence: Juncheng Liu Changxi Wang
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Müller SD, Both CP, Sponholz C, Voelker MT, Christiansen H, Niggli F, Schmitz A, Weiss M, Thomas J, Stehr SN, Piegeler T. Association between Intraoperative Blood Transfusion, Regional Anesthesia and Outcome after Pediatric Tumor Surgery for Nephroblastoma. Cancers (Basel) 2022; 14:cancers14225585. [PMID: 36428673 PMCID: PMC9688304 DOI: 10.3390/cancers14225585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recent data suggest that anesthesiologic interventions-e.g., the choice of the anesthetic regimen or the administration of blood products-might play a major role in determining outcome after tumor surgery. In contrast to adult patients, only limited data are available regarding the potential association of anesthesia and outcome in pediatric cancer patients. METHODS A retrospective multicenter study assessing data from pediatric patients (0-18 years of age) undergoing surgery for nephroblastoma between 2004 and 2018 was conducted at three academic centers in Europe. Overall and recurrence-free survival were the primary outcomes of the study and were evaluated for a potential impact of intraoperative administration of erythrocyte concentrates, the use of regional anesthesia and the choice of the anesthetic regimen. The length of stay on the intensive care unit, the time to hospital discharge after surgery and blood neutrophil-to-lymphocyte ratio were defined as secondary outcomes. RESULTS In total, data from 65 patients were analyzed. Intraoperative administration of erythrocyte concentrates was associated with a reduction in recurrence-free survival (hazard ratio (HR) 7.59, 95% confidence interval (CI) 1.36-42.2, p = 0.004), whereas overall survival (HR 5.37, 95% CI 0.42-68.4, p = 0.124) was not affected. The use of regional anesthesia and the choice of anesthetic used for maintenance of anesthesia did not demonstrate an effect on the primary outcomes. It was, however, associated with fewer ICU transfers, a shortened time to discharge and a decreased postoperative neutrophil-to-lymphocyte ratio. CONCLUSIONS The current study provides the first evidence for a possible association between blood transfusion as well as anesthesiologic interventions and outcome after pediatric cancer surgery.
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Affiliation(s)
- Sarah D. Müller
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, 04275 Leipzig, Germany
| | - Christian P. Both
- Department of Anesthesia, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Christoph Sponholz
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Jena, 07740 Jena, Germany
| | - Maria Theresa Voelker
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, 04275 Leipzig, Germany
| | - Holger Christiansen
- Department of Pediatric Oncology, Hematology and Hemostaseology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Felix Niggli
- Department of Pediatric Oncology, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Achim Schmitz
- Department of Anesthesia, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Markus Weiss
- Department of Anesthesia, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Jörg Thomas
- Department of Anesthesia, University Children’s Hospital Zurich, 8032 Zurich, Switzerland
| | - Sebastian N. Stehr
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, 04275 Leipzig, Germany
| | - Tobias Piegeler
- Department of Anesthesiology and Intensive Care, University Hospital Leipzig, 04275 Leipzig, Germany
- EuroPeriscope: The ESA-IC Onco-Anaesthesiology Research Group
- Correspondence: ; Tel.: +49-341-97-17700; Fax: +49-341-97-17709
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Chintagumpala MM, Perlman EJ, Tornwall B, Chi YY, Kim Y, Hoffer FA, Kalapurakal JA, Warwick AB, Shamberger RC, Khanna G, Hamilton TE, Gow KW, Paulino AC, Gratias EJ, Mullen EA, Geller JI, Fernandez CV, Ritchey ML, Grundy PE, Dome JS, Ehrlich PF. Outcomes based on histopathologic response to preoperative chemotherapy in children with bilateral Wilms tumor: A prospective study (COG AREN0534). Cancer 2022; 128:2493-2503. [PMID: 35383900 DOI: 10.1002/cncr.34219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/03/2022] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND An objective of the Children's Oncology Group AREN0534 Study was to improve the survival of patients with bilateral Wilms tumors (BWT) by using preoperative chemotherapy of limited duration and tailoring postoperative therapy based on histopathologic response. The authors report outcomes based on postoperative histopathologic responses. METHODS Patients with BWT received treatment with vincristine, dactinomycin, and doxorubicin for 6 or 12 weeks followed by surgery. Postoperative therapy was prescribed based on the highest risk tumor according to the International Society of Pediatric Oncology classification and the Children's Oncology Group staging system. RESULTS Analyses were performed on data from 180 evaluable children. The 4-year event-free survival (EFS) and overall survival (OS) rates were 81% (95% CI, 74%-87%) and 95% (95% CI, 91%-99%), respectively. Seven patients who had completely necrotic tumors had a 4-year EFS rate of 100%. Of 118 patients who had tumors with intermediate-risk histopathology, the 4-year EFS and OS rates were 82% (95% CI, 74%-90%) and 97% (95% CI, 94%-100%), respectively. Fourteen patients who had blastemal-type tumors had 4-year EFS and OS rates of 79% (95% CI, 56%-100%) and 93% (95% CI, 79%-100%), respectively. Eighteen patients who had diffuse anaplasia had 4-year EFS and OS rates of 61% (95% CI, 35%-88%) and 72% (95% CI, 47%-97%), respectively; and the 4-year EFS and OS rates of 7 patients who had focal anaplasia were 71% (95% CI, 38%-100%) and 100%, respectively. There was no difference in the outcomes of patients who had different histopathologic subtypes within the intermediate-risk group (P = .54). CONCLUSIONS A risk-adapted treatment approach for BWT results in excellent outcomes. This approach was not successful in improving the outcome of patients who had diffuse anaplasia.
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Affiliation(s)
| | - Elizabeth J Perlman
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Brett Tornwall
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Yueh-Yun Chi
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yeonil Kim
- Merck Research Laboratories, Merck & Company Inc, Rahway, New Jersey
| | - Fredric A Hoffer
- Department of Radiology, Fred Hutchison Cancer Center, University of Washington, Seattle, Washington
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois
| | - Anne B Warwick
- Department of Pediatrics, Uniformed Services University, Walter Reed National Military Medical Center, Washington, DC
| | - Robert C Shamberger
- Department of Surgery, Boston Children's Hospital and Dana Farber Cancer Center, Boston, Massachusetts
| | - Geetika Khanna
- School of Medicine, Washington University of St Louis, St Louis, Missouri
| | - Thomas E Hamilton
- Department of Surgery, Boston Children's Hospital and Dana Farber Cancer Center, Boston, Massachusetts
| | - Kenneth W Gow
- Department of Surgery, University of Washington, Seattle, Washington
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Elizabeth A Mullen
- Department of Surgery, Boston Children's Hospital and Dana Farber Cancer Center, Boston, Massachusetts
| | - James I Geller
- Division of Hematology/Oncology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Conrad V Fernandez
- Pediatrics and Bioethics, IWK Health Center, Halifax, Nova Scotia, Canada
| | - Michael L Ritchey
- Department of Urology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Paul E Grundy
- Department of Pediatrics and Oncology, University of Alberta Children's Hospital, Edmonton, Alberta, Canada
| | - Jeffrey S Dome
- Pediatric Surgery, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Peter F Ehrlich
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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11
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van Peer SE, Hol JA, van der Steeg AFW, van Grotel M, Tytgat GAM, Mavinkurve-Groothuis AMC, Janssens GOR, Littooij AS, de Krijger RR, Jongmans MCJ, Lilien MR, Drost J, Kuiper RP, van Tinteren H, Wijnen MHWA, van den Heuvel-Eibrink MM. Bilateral Renal Tumors in Children: The First 5 Years' Experience of National Centralization in The Netherlands and a Narrative Review of the Literature. J Clin Med 2021; 10:jcm10235558. [PMID: 34884260 PMCID: PMC8658527 DOI: 10.3390/jcm10235558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023] Open
Abstract
Survival of unilateral Wilms tumors (WTs) is exceeding 90%, whereas bilateral WTs have an inferior outcome. We evaluated all Dutch patients with bilateral kidney tumors, treated in the first five years of national centralization and reviewed relevant literature. We identified 24 patients in our center (2015–2020), 23 patients had WT/nephroblastomatosis and one renal cell carcinoma. Patients were treated according to SIOP-RTSG protocols. Chemotherapy response was observed in 26/34 WTs. Nephroblastomatosis lesions were stable (n = 7) or showed response (n = 18). Nephron-sparing surgery was performed in 11/22 patients undergoing surgery (n = 2 kidneys positive margins). Local stage in 20 patients with ≥1 WT revealed stage I (n = 7), II (n = 4) and III (n = 9). Histology was intermediate risk in 15 patients and high risk in 5. Three patients developed a WT in a treated nephroblastomatosis lesion. Two of 24 patients died following toxicity and renal failure, i.e., respectively dialysis-related invasive fungal infection and septic shock. Genetic predisposition was confirmed in 18/24 patients. Our literature review revealed that knowledge is scarce on bilateral renal tumor patients with metastases and that radiotherapy seems important for local stage III patients. Bilateral renal tumors are a therapeutic challenge. We describe management and outcome in a national expert center and summarized available literature, serving as baseline for further improvement of care.
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Affiliation(s)
- Sophie E. van Peer
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Correspondence:
| | - Janna A. Hol
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Alida F. W. van der Steeg
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Martine van Grotel
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Godelieve A. M. Tytgat
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Geert O. R. Janssens
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Radiation Oncology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Annemieke S. Littooij
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Radiology and Nuclear Medicine, Wilhelmina’s Children Hospital, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ronald R. de Krijger
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Pathology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marjolijn C. J. Jongmans
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Genetics, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marc R. Lilien
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Pediatric Nephrology, Wilhelmina’s Children Hospital, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jarno Drost
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Oncode Institute, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Roland P. Kuiper
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Genetics, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Harm van Tinteren
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Marc H. W. A. Wijnen
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Marry M. van den Heuvel-Eibrink
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
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12
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Turnbull V, Randhawa H, Wang Y, McGrath M, Braga LH. Nephron-sparing approach for familial bilateral synchronous Wilms tumors. Urology 2021; 160:199-202. [PMID: 34752848 DOI: 10.1016/j.urology.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
Wilms tumors are the most common renal malignancy of childhood, often presenting as asymptomatic abdominal masses. These tumors can occur either in a unilateral or bilateral fashion, with bilateral tumors more commonly associated with various genetic syndromes and familial inheritance with some known loci. Bilateral tumors present challenges with regards to balancing oncologic control with renal function. Here, we present an unusual case of a young female patient diagnosed with bilateral Wilms tumors on the background of a strong family history and unknown genetic loci.
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Affiliation(s)
- Victoria Turnbull
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | | | - Yuding Wang
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Melissa McGrath
- McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Luis H Braga
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada; Division of Urology, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
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13
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Groenendijk A, Spreafico F, de Krijger RR, Drost J, Brok J, Perotti D, van Tinteren H, Venkatramani R, Godziński J, Rübe C, Geller JI, Graf N, van den Heuvel-Eibrink MM, Mavinkurve-Groothuis AMC. Prognostic Factors for Wilms Tumor Recurrence: A Review of the Literature. Cancers (Basel) 2021; 13:cancers13133142. [PMID: 34201787 PMCID: PMC8268923 DOI: 10.3390/cancers13133142] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary A Wilms tumor is a childhood kidney tumor. In high-income countries, 90% of patients with this tumor survive. However, the tumor recurs in 15% of patients. It is important to identify the patients at risk of recurrence in order to adjust treatment in such a way that recurrence may potentially be prevented. However, we are currently unable to determine precisely which patients are at risk of recurrence. Therefore, we present an overview of factors that influence the risk of recurrence, also known as prognostic factors. These factors range from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. In addition to these factors, biological markers, such as genetic alterations, should be studied more intensively as these markers may be able to better identify patients at risk of tumor recurrence. Abstract In high-income countries, the overall survival of children with Wilms tumors (WT) is ~90%. However, overall, 15% of patients experience tumor recurrence. The adverse prognostic factors currently used for risk stratification (advanced stage, high risk histology, and combined loss of heterozygosity at 1p and 16q in chemotherapy-naïve WTs) are present in only one third of these cases, and the significance of these factors is prone to change with advancing knowledge and improved treatment regimens. Therefore, we present a comprehensive, updated overview of the published prognostic variables for WT recurrence, ranging from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. Improved first-line treatment regimens based on clinicopathological characteristics and advancing knowledge on copy number variations unveil the importance of further investigating the significance of biological markers for WT recurrence in international collaborations.
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Affiliation(s)
- Alissa Groenendijk
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Correspondence:
| | - Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Oncode Institute, 3584 CS Utrecht, The Netherlands
| | - Jesper Brok
- Department of Pediatric Oncology and Hematology, Rigshospitalet, 2100 Copenhagen, Denmark;
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Daniela Perotti
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | | | - Jan Godziński
- Department of Pediatric Surgery, Marciniak Hospital, Fieldorfa 2, 54-049 Wroclaw, Poland;
- Department of Pediatric Traumatology and Emergency Medicine, Wroclaw Medical University, Bujwida 44a, 50-345 Wroclaw, Poland
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - James I. Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA;
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
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14
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Hol JA, Jongmans MCJ, Sudour‐Bonnange H, Ramírez‐Villar GL, Chowdhury T, Rechnitzer C, Pal N, Schleiermacher G, Karow A, Kuiper RP, de Camargo B, Avcin S, Redzic D, Wachtel A, Segers H, Vujanic GM, van Tinteren H, Bergeron C, Pritchard‐Jones K, Graf N, van den Heuvel‐Eibrink MM. Clinical characteristics and outcomes of children with WAGR syndrome and Wilms tumor and/or nephroblastomatosis: The 30-year SIOP-RTSG experience. Cancer 2021; 127:628-638. [PMID: 33146894 PMCID: PMC7894534 DOI: 10.1002/cncr.33304] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND WAGR syndrome (Wilms tumor, aniridia, genitourinary anomalies, and range of developmental delays) is a rare contiguous gene deletion syndrome with a 45% to 60% risk of developing Wilms tumor (WT). Currently, surveillance and treatment recommendations are based on limited evidence. METHODS Clinical characteristics, treatments, and outcomes were analyzed for patients with WAGR and WT/nephroblastomatosis who were identified through International Society of Pediatric Oncology Renal Tumor Study Group (SIOP-RTSG) registries and the SIOP-RTSG network (1989-2019). Events were defined as relapse, metachronous tumors, or death. RESULTS Forty-three patients were identified. The median age at WT/nephroblastomatosis diagnosis was 22 months (range, 6-44 months). The overall stage was available for 40 patients, including 15 (37.5%) with bilateral disease and none with metastatic disease. Histology was available for 42 patients; 6 nephroblastomatosis without further WT and 36 WT, including 19 stromal WT (52.8%), 12 mixed WT (33.3%), 1 regressive WT (2.8%) and 2 other/indeterminable WT (5.6%). Blastemal type WT occurred in 2 patients (5.6%) after prolonged treatment for nephroblastomatosis; anaplasia was not reported. Nephrogenic rests were present in 78.9%. Among patients with WT, the 5-year event-free survival rate was 84.3% (95% confidence interval, 72.4%-98.1%), and the overall survival rate was 91.2% (95% confidence interval, 82.1%-100%). Events (n = 6) did not include relapse, but contralateral tumor development (n = 3) occurred up to 7 years after the initial diagnosis, and 3 deaths were related to hepatotoxicity (n = 2) and obstructive ileus (n = 1). CONCLUSIONS Patients with WAGR have a high rate of bilateral disease and no metastatic or anaplastic tumors. Although they can be treated according to existing WT protocols, intensive monitoring of toxicity and surveillance of the remaining kidney(s) are advised. LAY SUMMARY WAGR syndrome (Wilms tumor, aniridia, genitourinary anomalies, and range of developmental delays) is a rare genetic condition with an increased risk of developing Wilms tumor. In this study, 43 patients with WAGR and Wilms tumor (or Wilms tumor precursor lesions/nephroblastomatosis) were identified through the international registry of the International Society of Pediatric Oncology Renal Tumor Study Group (SIOP-RTSG) and the SIOP-RTSG network. In many patients (37.5%), both kidneys were affected. Disease spread to other organs (metastases) did not occur. Overall, this study demonstrates that patients with WAGR syndrome and Wilms tumor can be treated according to existing protocols. However, intensive monitoring of treatment complications and surveillance of the remaining kidney(s) are advised.
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Affiliation(s)
- Janna A. Hol
- Princess Máxima Center for Pediatric OncologyUtrechtthe Netherlands
| | - Marjolijn C. J. Jongmans
- Princess Máxima Center for Pediatric OncologyUtrechtthe Netherlands
- Department of GeneticsUniversity Medical Center Utrecht/Wilhelmina Children's HospitalUtrechtthe Netherlands
| | | | | | - Tanzina Chowdhury
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUnited Kingdom
| | | | - Niklas Pal
- Department of Pediatric OncologyKarolinska University HospitalSolnaSweden
| | | | - Axel Karow
- Department of Pediatrics and Adolescent MedicineFriedrich‐Alexander University Erlangen‐NürnbergErlangenGermany
| | - Roland P. Kuiper
- Princess Máxima Center for Pediatric OncologyUtrechtthe Netherlands
| | - Beatriz de Camargo
- Pediatric Hematology‐Oncology ProgramInstituto Nacional de CancerRio de JaneiroBrazil
| | - Simona Avcin
- Department of Pediatric OncologyUniversity Children's HospitalLjubljanaSlovenia
| | - Danka Redzic
- Department of Hemato‐OncologyMother and Child Health Care Institute of SerbiaBelgradeSerbia
| | - Antonio Wachtel
- Pediatric OncologyInstituto Nacional de Enfermedades NeoplásicasLimaPeru
| | - Heidi Segers
- Department of Pediatric Hemato‐OncologyUniversity Hospital LeuvenLeuvenBelgium
| | | | - Harm van Tinteren
- Department of BiometricsNetherlands Cancer InstituteAmsterdamthe Netherlands
| | - Christophe Bergeron
- Institut d'Hematologie et d'Oncologie PédiatriqueCentre Léon BérardLyonFrance
| | - Kathy Pritchard‐Jones
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUnited Kingdom
| | - Norbert Graf
- Department of Pediatric Oncology and HematologySaarland UniversityHomburgGermany
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15
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Abstract
The prognosis of children with Wilms tumour has greatly improved since the introduction of adjuvant radiotherapy and chemotherapy more than 70 years ago with a current overall long-term survival approaching 90%. Before this, surgery was the only option with around 20% survival, even in low-risk categories. The focus is now on management options for those patients in specific subgroups, who continue to have lower event-free survival and who suffer from the long-term effects of treatment. These include those with anaplastic histology, bilateral Wilms, biologically high-risk tumours and those that relapse (Aldrink et al. in J Pediatr Surg 54(3):390-397, 2019). The major advances that have already been made in risk assessment and tailoring the chemotherapy/radiotherapy to achieve maximum advantage with minimum toxicity and long-term morbidity have been predicated on safe and complete resection and staging of the tumour. There are, however, still surgical challenges faced with respect to resection of 'complex' tumours; thus, surgeons need to understand their role and advance their expertise in the overall treatment of children with Wilms tumour. These include very large tumours not responding to chemotherapy, ruptured tumours, tumours with intravascular invasion into the inferior vena cava (± 10%), heart and hepatic veins (± 4%) and Wilms tumours in horseshoe kidneys (< 1%) (Kieran and Ehrlich in Urol Oncol https://doi.org/10.1016/j.urolonc.2015.05.029, 2015). This review describes surgical strategies and techniques used in these situations, gleaned from the authors' experience in the surgical management of over 300 children with Wilms tumours in our centres over the last 30 years.
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Affiliation(s)
- Sharon Cox
- Division of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Cenk Büyükünal
- Division of Paediatric Urology, Department of Paediatric Surgery, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Alastair J W Millar
- Division of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
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16
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Kooijmans ECM, Bökenkamp A, Tjahjadi NS, Tettero JM, van Dulmen‐den Broeder E, van der Pal HJH, Veening MA. Early and late adverse renal effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev 2019; 3:CD008944. [PMID: 30855726 PMCID: PMC6410614 DOI: 10.1002/14651858.cd008944.pub3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improvements in diagnostics and treatment for paediatric malignancies resulted in a major increase in survival. However, childhood cancer survivors (CCS) are at risk of developing adverse effects caused by multimodal treatment for their malignancy. Nephrotoxicity is a known side effect of several treatments, including cisplatin, carboplatin, ifosfamide, radiotherapy and nephrectomy, and can cause glomerular filtration rate (GFR) impairment, proteinuria, tubulopathy, and hypertension. Evidence about the long-term effects of these treatments on renal function remains inconclusive. It is important to know the risk of, and risk factors for, early and late adverse renal effects, so that ultimately treatment and screening protocols can be adjusted. This review is an update of a previously published Cochrane Review. OBJECTIVES To evaluate existing evidence on the effects of potentially nephrotoxic treatment modalities on the prevalence of renal dysfunction in survivors treated for childhood cancer with a median or mean survival of at least one year after cessation of treatment, where possible in comparison with the general population or CCS treated without potentially nephrotoxic treatment. In addition, to evaluate evidence on associated risk factors, such as follow-up duration, age at time of diagnosis and treatment combinations, as well as the effect of doses. SEARCH METHODS On 31 March 2017 we searched the following electronic databases: CENTRAL, MEDLINE and Embase. In addition, we screened reference lists of relevant studies and we searched the congress proceedings of the International Society of Pediatric Oncology (SIOP) and The American Society of Pediatric Hematology/Oncology (ASPHO) from 2010 to 2016/2017. SELECTION CRITERIA Except for case reports, case series and studies including fewer than 20 participants, we included studies with all study designs that reported on renal function (one year or longer after cessation of treatment), in CCS treated before the age of 21 years with cisplatin, carboplatin, ifosfamide, radiation involving the kidney region, a nephrectomy, or a combination of two or more of these treatments. When not all treatment modalities were described or the study group of interest was unclear, a study was not eligible for the evaluation of prevalence. We still included it for the assessment of risk factors if it had performed a multivariable analysis. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction using standardised data collection forms. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Apart from the remaining 37 studies included from the original review, the search resulted in the inclusion of 24 new studies. In total, we included 61 studies; 46 for prevalence, six for both prevalence and risk factors, and nine not meeting the inclusion criteria, but assessing risk factors. The 52 studies evaluating the prevalence of renal dysfunction included 13,327 participants of interest, of whom at least 4499 underwent renal function testing. The prevalence of adverse renal effects ranged from 0% to 84%. This variation may be due to diversity of included malignancies, received treatments, reported outcome measures, follow-up duration and the methodological quality of available evidence.Seven out of 52 studies, including 244 participants, reported the prevalence of chronic kidney disease, which ranged from 2.4% to 32%.Of these 52 studies, 36 studied a decreased (estimated) GFR, including at least 432 CCS, and found it was present in 0% to 73.7% of participants. One eligible study reported an increased risk of glomerular dysfunction after concomitant treatment with aminoglycosides and vancomycin in CCS receiving total body irradiation (TBI). Four non-eligible studies assessing a total cohort of CCS, found nephrectomy and (high-dose (HD)) ifosfamide as risk factors for decreased GFR. The majority also reported cisplatin as a risk factor. In addition, two non-eligible studies showed an association of a longer follow-up period with glomerular dysfunction.Twenty-two out of 52 studies, including 851 participants, studied proteinuria, which was present in 3.5% to 84% of participants. Risk factors, analysed by three non-eligible studies, included HD cisplatin, (HD) ifosfamide, TBI, and a combination of nephrectomy and abdominal radiotherapy. However, studies were contradictory and incomparable.Eleven out of 52 studies assessed hypophosphataemia or tubular phosphate reabsorption (TPR), or both. Prevalence ranged between 0% and 36.8% for hypophosphataemia in 287 participants, and from 0% to 62.5% for impaired TPR in 246 participants. One non-eligible study investigated risk factors for hypophosphataemia, but could not find any association.Four out of 52 studies, including 128 CCS, assessed the prevalence of hypomagnesaemia, which ranged between 13.2% and 28.6%. Both non-eligible studies investigating risk factors identified cisplatin as a risk factor. Carboplatin, nephrectomy and follow-up time were other reported risk factors.The prevalence of hypertension ranged from 0% to 50% in 2464 participants (30/52 studies). Risk factors reported by one eligible study were older age at screening and abdominal radiotherapy. A non-eligible study also found long follow-up time as risk factor. Three non-eligible studies showed that a higher body mass index increased the risk of hypertension. Treatment-related risk factors were abdominal radiotherapy and TBI, but studies were inconsistent.Because of the profound heterogeneity of the studies, it was not possible to perform meta-analyses. Risk of bias was present in all studies. AUTHORS' CONCLUSIONS The prevalence of adverse renal effects after treatment with cisplatin, carboplatin, ifosfamide, radiation therapy involving the kidney region, nephrectomy, or any combination of these, ranged from 0% to 84% depending on the study population, received treatment combination, reported outcome measure, follow-up duration and methodological quality. With currently available evidence, it was not possible to draw solid conclusions regarding the prevalence of, and treatment-related risk factors for, specific adverse renal effects. Future studies should focus on adequate study designs and reporting, including large prospective cohort studies with adequate control groups when possible. In addition, these studies should deploy multivariable risk factor analyses to correct for possible confounding. Next to research concerning known nephrotoxic therapies, exploring nephrotoxicity after new therapeutic agents is advised for future studies. Until more evidence becomes available, CCS should preferably be enrolled into long-term follow-up programmes to monitor their renal function and blood pressure.
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Affiliation(s)
- Esmee CM Kooijmans
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Arend Bökenkamp
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatric NephrologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nic S Tjahjadi
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Jesse M Tettero
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Helena JH van der Pal
- Princess Maxima Center for Pediatric Oncology, KE.01.129.2PO Box 85090UtrechtNetherlands3508 AB
| | - Margreet A Veening
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
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17
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Saha H, Ghosh D, Biswas SK, Mishra PK, Saha K, Chatterjee U. Synchronous Bilateral Wilms Tumor: Five-Year Single-Center Experience with Assessment of Quality of Life. J Indian Assoc Pediatr Surg 2019; 24:52-60. [PMID: 30686888 PMCID: PMC6322171 DOI: 10.4103/jiaps.jiaps_42_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: Synchronous Bilateral Wilms tumor (sBWT). Aims: This study aimed to assess the outcome of patients with sBWT treated on SIOP protocol. Settings and Design: Retrospective and prospective randomized study. Subjects and Methods: SIOP 93-01 protocol was used to study nine patients of sBWT in a single center and followed up over a period from 2 to 5 years. Statistical Analysis Used: Unpaired t-test and Mann–Whitney U-test were used for analysis. Results: Of nine patients, six were included in the study as three patients lost to follow-up. Among the six patients, there were four girls and two boys with a median age of 2 years. Mean regression in the size of tumor was 87% in four out of six patients. Tumor with unfavorable histology showed 32% response (ratio of favorable: unfavorable histology 2:1). Event-free survival rate was 81.3% and overall survival was 90% over 2–5 years. Recurrence was seen in two patients of whom one had Denys–Drash syndrome. Mean DTPA glomerular filtration rate was 91.4/ml/min/1.73 m2 preoperatively and that of 3 months after completion of treatment was 84/ml/min/1.73 m2. Health-related quality of life (HRQOL) using Pediatric Quality of Life Inventory and Lansky Play Performance Scale revealed significant improvement results of all functioning domains such as physical, social, emotional, and school subscales with P < 0.05 and performance scale (P < 0.04). Conclusions: We suggest SIOP protocol for sBWT and bilateral nephron-sparing surgery in two stages. However, long-term follow-up is required to assess the ultimate renal function outcome. HRQOL is an essential guide in improving the conditions of pediatric cancer survivors.
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Affiliation(s)
- Hinglaj Saha
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Dipak Ghosh
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Somak Kumar Biswas
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Prafulla Kumar Mishra
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Kaushik Saha
- Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Uttara Chatterjee
- Department of Pathology, SSKM and IPGMER Medical College and Hospital, Kolkata, West Bengal, India
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18
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Nephron Sparing Surgery for Synchronous Bilateral Wilms-Operative Steps. Indian J Surg Oncol 2018; 9:601-604. [PMID: 30538398 DOI: 10.1007/s13193-018-0793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022] Open
Abstract
Approximately 5% of children with Wilms tumor present with bilateral disease. The treatment challenge is to achieve a high cure rate while maintaining adequate long-term renal function. We report the feasibility and outcome of nephron sparing surgery in a child with bilateral Wilms tumor who was treated at our institution.
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19
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Han Q, Li K, Dong K, Xiao X, Yao W, Liu G. Clinical features, treatment, and outcomes of bilateral Wilms' tumor: A systematic review and meta-analysis. J Pediatr Surg 2018; 53:2465-2469. [PMID: 30274708 DOI: 10.1016/j.jpedsurg.2018.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Wilms' tumor(WT) is the most common malignant renal tumor of childhood. Despite the good prognosis of WT, bilateral Wilms' tumor (BWT) still has a poor outcome. We systematically reviewed the literature on BWT, aiming to define its clinical features, treatment, and outcomes. METHODS PubMed, OVID EMbase, Web of Science, and Cochrane Library were systematically searched for studies published from 1980 to 2017. Case series and comparative studies reported clinical data of BWT patients were included. RESULTS A total of 32 studies comprising 1457 patients were retained for primary outcome. Hemihypertrophy, cryptorchidism, and Beckwith-Wiedemann syndrome(BWS) are the most common congenital anomalies and syndrome. 86% of patients had favorable histology (FH). Patients with local stage I or II accounted for 64%, and 12.6% had metastasis at diagnosis. Bilateral nephron-sparing surgery (NSS) was achieved in 33.8%. Recurrence and renal failure occurred in 20% and 8%. The overall survival (OS) was 73%. In comparative studies, OS of patients undergoing bilateral NSS was similar to that of other operation types. CONCLUSION Prognosis of BWT has been improved but is significantly poorer than WT. Bilateral NSS was recommended by most centers to preserve more renal volume. However, finding a balance between retaining renal function and avoiding recurrence remains a question. TYPE OF STUDY Systematic review. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Qilei Han
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China.
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Xianmin Xiao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
| | - Gongbao Liu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai, China
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20
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Aldrink JH, Cost NG, McLeod DJ, Bates DG, Stanek JR, Smith EA, Ehrlich PF. Technical Considerations for Nephron-Sparing Surgery in Children: What Is Needed to Preserve Renal Units? J Surg Res 2018; 232:614-620. [PMID: 30463781 DOI: 10.1016/j.jss.2018.07.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/19/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chemotherapy is used preoperatively for children with bilateral Wilms tumor (BWT) or unilateral high-risk Wilms tumor (UHRWT) to promote tumor regression to facilitate renal preservation with nephron-sparing surgery (NSS). In adults, various surgical techniques have been described to preserve renal tissue. Few studies have examined the use of surgical adjuncts in NSS in children with renal tumors. METHODS We performed a multi-institutional retrospective review of patients with BWT or UHRWT. Patient demographics, tumor size at diagnosis, following neoadjuvant chemotherapy, utilization of surgical adjuncts including intraoperative ultrasound (IOUS), margin status, complications, renal function, and follow-up were recorded. RESULTS The cohort comprised 23 patients: 18 BWT, 3 UHRWT, and 2 patients with solitary kidney. Twenty-two of the 23 patients had successful NSS. IOUS was used 19 times, and seven had positive margins after surgery. Cooling/vascular isolation was used six times. At a median follow-up of 18 mo, median estimated glomerular filtration rate Schwartz was 126 mL/min/1.73 m2 and median serum creatinine 0.39 mg/dL in the 22 patients who had successful NSS. There have been no tumor recurrences. CONCLUSIONS In patients with BWT and UHRWT, surgical adjuncts such as cooling/vascular isolation are uncommonly performed. IOUS may be helpful but does not guarantee negative microscopic margins. LEVEL OF EVIDENCE Level 4, Case series with no comparison group.
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Affiliation(s)
- Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Nicholas G Cost
- Division of Pediatric Urology, Department of Surgery, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Daryl J McLeod
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - David Gregory Bates
- Division of Pediatric Radiology, Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph R Stanek
- Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Biostatistics, Nationwide Children's Hospital, Columbus, Ohio
| | - Ethan A Smith
- Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Peter F Ehrlich
- Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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21
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Tan XH, Zhang DY, Liu X, Lin T, He DW, Li XL, Wei GH. Retrospective analysis to determine outcomes of patients with bilateral Wilms tumor undergoing nephron sparing surgery: 15-year tertiary single-institution experience. Pediatr Surg Int 2018; 34:427-433. [PMID: 29368077 DOI: 10.1007/s00383-018-4232-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To describe our clinical experience with nephron sparing surgery (NSS) for bilateral Wilms tumor and evaluate the outcomes of patients treated at one of the largest pediatric medical centers in China. METHODS Medical records of children with bilateral Wilms tumor undergoing NSS in the Children's Hospital of Chongqing Medical University during a 15-year period were retrospectively analyzed. Data collected were composed of age at surgery, tumor response, tumor rupture during resection, final pathologic margins, use of radiation therapy, pathology reports, renal function, and patient survival. RESULTS A total of 18 eligible patients (10 males, 8 females) with bilateral Wilms tumor at a mean age of 2.28 ± 1.12 years were identified. The administration of preoperative chemotherapy did not result in universally successful outcomes. All children underwent successfully unilateral or bilateral NSS, of which one had positive pathologic margins and five received radiation therapy postoperatively. The rates of tumor rupture and positive lymph nodes involvement were 11.1 and 19.4%, respectively. The pathological study showed favorable histology and unfavorable histology in 32 and 4 kidneys, respectively. The 4-year event-free survival and overall survival rates were 68.18 and 85.56%. In univariable analysis, tumor histology (p = 0.0028) and disease stage (p = 0.0303) appeared significantly associated with overall survival. After a median follow-up period of 41.5 months (range 10-89), three of the surviving patients were diagnosed with hypertension and one had renal insufficiency. CONCLUSIONS Our experience suggests that NSS has become a feasible and effective option with good oncologic outcomes. Further research, ideally in a multicenter randomized manner, is warranted to better assess the role of NSS in this challenging clinical scenario.
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Affiliation(s)
- Xiao-Hui Tan
- Department of Urology, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd RD, Yuzhong District, Chongqing, 400014, China
| | - De-Ying Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd RD, Yuzhong District, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd RD, Yuzhong District, Chongqing, 400014, China.
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd RD, Yuzhong District, Chongqing, 400014, China
| | - Da-Wei He
- Department of Urology, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd RD, Yuzhong District, Chongqing, 400014, China.
| | - Xu-Liang Li
- Department of Urology, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd RD, Yuzhong District, Chongqing, 400014, China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd RD, Yuzhong District, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
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22
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van den Heuvel-Eibrink MM, Hol JA, Pritchard-Jones K, van Tinteren H, Furtwängler R, Verschuur AC, Vujanic GM, Leuschner I, Brok J, Rübe C, Smets AM, Janssens GO, Godzinski J, Ramírez-Villar GL, de Camargo B, Segers H, Collini P, Gessler M, Bergeron C, Spreafico F, Graf N. Position paper: Rationale for the treatment of Wilms tumour in the UMBRELLA SIOP-RTSG 2016 protocol. Nat Rev Urol 2017; 14:743-752. [PMID: 29089605 DOI: 10.1038/nrurol.2017.163] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Renal Tumour Study Group of the International Society of Paediatric Oncology (SIOP-RTSG) has developed a new protocol for the diagnosis and treatment of childhood renal tumours, the UMBRELLA SIOP-RTSG 2016 (the UMBRELLA protocol), to continue international collaboration in the treatment of childhood renal tumours. This protocol will support integrated biomarker and imaging research, focussing on assessing the independent prognostic value of genomic changes within the tumour and the volume of the blastemal component that survives preoperative chemotherapy. Treatment guidelines for Wilms tumours in the UMBRELLA protocol include recommendations for localized, metastatic, and bilateral disease, for all age groups, and for relapsed disease. These recommendations have been established by a multidisciplinary panel of leading experts on renal tumours within the SIOP-RTSG. The UMBRELLA protocol should promote international collaboration and research and serve as the SIOP-RTSG best available treatment standard.
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Affiliation(s)
- Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
| | - Janna A Hol
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
| | - Kathy Pritchard-Jones
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom
| | - Harm van Tinteren
- Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Rhoikos Furtwängler
- Department of Paediatric Oncology & Haematology, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Arnauld C Verschuur
- Department of Paediatric Oncology & Haematology, La Timone Children's Hospital, 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Gordan M Vujanic
- Department of Cellular Pathology, University Hospital of Wales, Cardiff University School of Medicine, Heath Park, Eastern Ave, Cardiff, CF14 4XW, United Kingdom
| | - Ivo Leuschner
- Kiel Paediatric Tumour Registry, Department of Paediatric Pathology, University Hospital of Kiel, Christian-Albrechts-Platz 4, 24118, Kiel, Germany
| | - Jesper Brok
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom
| | - Christian Rübe
- Department of Radiotherapy, University Hospital of the Saarland, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Anne M Smets
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Geert O Janssens
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Godzinski
- Department of Paediatric Surgery, Marciniak Hospital, Fieldorfa 2, 54-049, Wroclaw, Poland
- Department of Paediatric Traumatology and Emergency Medicine, Medical University, Wybrzeze Ludwika Pasteura 1, 50-367, Wroclaw, Poland
| | - Gema L Ramírez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, S/N, 41013 Seville, Spain
| | - Beatriz de Camargo
- Paediatric Haematology-Oncology Program, Instituto Nacional de Cancer (INCA), Praça Cruz Vermelha, 23, Rio de Janeiro, 20230-130, Brazil
| | - Heidi Segers
- Department of Paediatric Oncology, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Paola Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Manfred Gessler
- Biocenter of the University of Wuerzburg, Developmental Biochemistry, and Comprehensive Cancer Center Mainfranken, Josef-Schneider-Straße 6, 97080, Wuerzburg, Germany
| | - Christophe Bergeron
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Filippo Spreafico
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Norbert Graf
- Department of Paediatric Oncology & Haematology, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany
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Ehrlich P, Chi YY, Chintagumpala MM, Hoffer FA, Perlman EJ, Kalapurakal JA, Warwick A, Shamberger RC, Khanna G, Hamilton TE, Gow KW, Paulino AC, Gratias EJ, Mullen EA, Geller JI, Grundy PE, Fernandez CV, Ritchey ML, Dome JS. Results of the First Prospective Multi-institutional Treatment Study in Children With Bilateral Wilms Tumor (AREN0534): A Report From the Children's Oncology Group. Ann Surg 2017; 266:470-478. [PMID: 28795993 PMCID: PMC5629006 DOI: 10.1097/sla.0000000000002356] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Children's Oncology Group study AREN0534 aimed to improve event-free survival (EFS) and overall survival (OS) while preserving renal tissue by intensifying preoperative chemotherapy, completing definitive surgery by 12 weeks from diagnosis, and modifying postoperative chemotherapy based on histologic response. BACKGROUND No prospective therapeutic clinic trials in children with bilateral Wilms tumors (BWT) exist. Historical outcomes for this group were poor and often involved prolonged chemotherapy; on NWTS-5, 4-year EFS for all children with BWT was 56%. METHODS Patients were enrolled and imaging studies were centrally reviewed to assess for bilateral renal lesions. They were treated with 3-drug induction chemotherapy (vincristine, dactinomycin, and doxorubicin) for 6 or 12 weeks based on radiographic response followed by surgery and further chemotherapy determined by histology. Radiation therapy was provided for postchemotherapy stage III and IV disease. RESULTS One hundred eighty-nine of 208 patients were evaluable. Four-year EFS and OS were 82.1% (95% CI: 73.5%-90.8%) and 94.9% (95% CI: 90.1%-99.7%. Twenty-three patients relapsed and 7 had disease progression. After induction chemotherapy 163 of 189 (84.0%) underwent definitive surgical treatment in at least 1 kidney by 12 weeks and 39% retained parts of both kidneys. Surgical approaches included: unilateral total nephrectomy with contralateral partial nephrectomy (48%), bilateral partial nephrectomy (35%), unilateral total nephrectomy (10.5%), unilateral partial nephrectomy (4%), and bilateral total nephrectomies (2.5%). CONCLUSION This treatment approach including standardized 3-drug preoperative chemotherapy, surgical resection within 12 weeks of diagnosis and response and histology-based postoperative therapy improved EFS and OS and preservation of renal parenchyma compared with historical outcomes for children with BWT.
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Affiliation(s)
- Peter Ehrlich
- *Section of Pediatric Surgery CS Mott Children's Hospital, University of Michigan, Ann Arbor MI †COG Data Center, University of Florida, Gainesville, FL ‡Texas Children's Cancer Center at Baylor College of Medicine, Houston, TX §Fred Hutchison Cancer Center, University of Washington, Seattle, WA ¶Ann and Robert H Lurie Children's Hospital, Chicago, IL ||Northwestern University, Chicago, IL **Walter Reed National Military Medical Center, Washington DC ††Boston Children's Hospital and Dana Farber Cancer Center, Boston, MA ‡‡Washington University of St Louis, St Louis, MO §§University of Washington, Seattle, WA ¶¶MD Anderson Cancer Center, Houston, TX ||||Children's Oncology Group, Philadelphia, PA ***Cincinnati Children's Hospital, Cincinnati, OH †††University of Alberta Children's Hospital, Edmonton, Alberta, Canada ‡‡‡IWK Children's Hospital, Halifax, Nova Scotia, Canada §§§Phoenix Children's Hospital, Phoenix, AZ ¶¶¶Children National Medical Center, Washington, DC
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Charlton J, Irtan S, Bergeron C, Pritchard-Jones K. Bilateral Wilms tumour: a review of clinical and molecular features. Expert Rev Mol Med 2017; 19:e8. [PMID: 28716159 PMCID: PMC5687181 DOI: 10.1017/erm.2017.8] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Wilms tumour (WT) is the most common paediatric kidney cancer and affects approximately one in 10 000 children. The tumour is associated with undifferentiated embryonic lesions called nephrogenic rests (NRs) or, when diffuse, nephroblastomatosis. WT or NRs can occur in both kidneys, termed bilateral disease, found in only 5-8% of cases. Management of bilateral WT presents a major clinical challenge in terms of maximising survival, preserving renal function and understanding underlying genetic risk. In this review, we compile clinical data from 545 published cases of bilateral WT and discuss recent progress in understanding the molecular basis of bilateral WT and its associated precursor NRs in the context of the latest radiological, surgical and epidemiological features.
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Affiliation(s)
- Jocelyn Charlton
- UCL Institute of Child Health, University College London, London, UK
| | - Sabine Irtan
- UCL Institute of Child Health, University College London, London, UK
- Paediatric Surgery Department, Trousseau Hospital, Paris, France
| | - Christophe Bergeron
- Centre Léon Bérard, Institut d'Hématologie et d'Oncologie Pédiatrie, Lyon, France
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Abstract
Wilms tumour is named after Max Wilms. It is an embryonal tumour derived from the metanephros. It is the commonest childhood renal tumour and the third commonest paediatric malignancy. Synchronous bilateral Wilms tumours (BWT) represent 4-7% of all Wilms tumours (WT) and present at a younger age than unilateral Wilms tumours. At least 10% of synchronous BWTs have unfavourable histology, and up to 22% are associated with genitourinary abnormalities, aniridia, WAGR syndrome, Denys-Drash syndrome, hemihypertrophy, or one of the other overgrowth syndromes. The long-term disease-free survival rate for patients with unilateral WT is approaching 90%, and is around 70% for those with metastatic disease. For both synchronous and metachronous Wilms tumours the prognosis is less favourable with reported cure rates approaching 80% in the best centres and lower in resource poor settings. There is potential for a reduced quality of life due to renal insufficiency and the possible need for renal transplantation. The major clinical challenge in BWTs is preservation of functioning renal tissue using nephron-sparing surgical techniques, while achieving cure with minimum therapy-related morbidity. Mortality is generally associated with progressive disease of anaplastic tumours. Chemotherapy followed by nephron-sparing surgery has been able, in most cases, to eradicate the tumour while preserving renal function. Radiotherapy has largely been avoided because of fears of long-term radiation injury to the residual functioning renal mass. Patient selection, appropriate pre- and post-operative chemotherapy and skilled surgical techniques all contribute to excellent outcomes where these are achievable.
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Affiliation(s)
- Alastair J W Millar
- Emeritus Professor of Paediatric Surgery, Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Sharon Cox
- Associate Professor and Head of Clinical Unit, Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Alan Davidson
- Associate Professor and Head of Division of Haematology and Oncology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Abstract
Wilms tumour is named after Max Wilms. It is an embryonal tumour derived from the metanephros. It is the commonest childhood renal tumour and the third commonest paediatric malignancy. Synchronous bilateral Wilms tumours (BWT) represent 4-7% of all Wilms tumours (WT) and present at a younger age than unilateral Wilms tumours. At least 10% of synchronous BWTs have unfavourable histology, and up to 22% are associated with genitourinary abnormalities, aniridia, WAGR syndrome, Denys-Drash Syndrome, hemihypertrophy, or one of the other overgrowth syndromes. The long-term disease-free survival (DFS) rate for patients with unilateral Wilms' tumours is approaching 90%, and is around 70% for those with metastatic disease. For both synchronous and metachronous Wilms tumours the prognosis is less favourable with reported cure rates approaching 80% in the best centres and lower in resource poor settings. There is potential for a reduced quality of life due to renal insufficiency and the possible need for renal transplantation. The major clinical challenge in BWTs is preservation of functioning renal tissue using nephron sparing surgical techniques, while achieving cure with minimum therapy-related morbidity. Mortality is generally associated with progressive disease of anaplastic tumours. Chemotherapy followed by nephron sparing surgery has been able, in most cases, to eradicate the tumour while preserving renal function. Radiotherapy has largely been avoided because of fears of long term radiation injury to the residual functioning renal mass. Patient selection, appropriate pre- and post-operative chemotherapy and skilled surgical techniques all contribute to excellent outcomes where these are achievable.
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Scalabre A, Bergeron C, Brioude F, Dainese L, Cropet C, Coulomb L'hermine A, Pasqualini C, Auber F, Verschuur A, Schleiermacher G, Le Bouc Y, Audry G, Irtan S. Is Nephron Sparing Surgery Justified in Wilms Tumor With Beckwith-Wiedemann Syndrome or Isolated Hemihypertrophy? Pediatr Blood Cancer 2016; 63:1571-7. [PMID: 27228957 DOI: 10.1002/pbc.26073] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Patients with Beckwith-Wiedemann syndrome (BWS) or isolated hemihypertrophy (HH) treated for a Wilms tumor (WT) carry an increased risk of developing metachronous lesion. There are no guidelines on precise indications for nephron sparing surgery (NSS) in unilateral WT (UWT). The objective of this retrospective study was to delineate the indications of NSS in patients with BWS/HH treated for WT and to evaluate their outcome. PROCEDURE All cases of BWS/HH treated for a WT according to SIOP protocols from 1980 to 2013 were reviewed. Patients were divided into two groups (G): isolated UWT (G1) and bilateral lesions (G2) with two subgroups: bilateral tumors suspected of malignancy (G2a), and unilateral tumor suspected of malignancy with contralateral nephroblastomatosis (G2b). RESULTS Forty-six patients were included (34 G1, three G2a, and nine G2b). Nine NSS and 25 total nephrectomies (TN) were performed in G1, two bilateral NSS and one NSS with contralateral TN in G2a, and eight NSS and one TN in G2b. The 3-year event-free survival was 92.3% (95% CI [77.9-97.5%]). One death occurred after a local relapse following a TN for a stage III stromal WT (G1) and another after a combined local and distant relapse following a NSS for a stage I diffuse anaplastic WT (G2b). There were two metachronous WT (4%), 3 years after a TN (G1) and 12 years after a NSS (G2b). CONCLUSIONS NSS is recommended in bilateral WT and may be an option in selected UWT patients with BWS/HH because it was not associated with an increased risk of local relapse.
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Affiliation(s)
- Aurélien Scalabre
- Sorbonne Universités, UPMC Univ Paris 06, APHP Hôpital Armand Trousseau, Pediatric Surgery, 75012 Paris, France
| | - Christophe Bergeron
- Institut d'Hématologie et d'Oncologie Pédiatrique, Department of Pediatrics, 690008 Lyon, France
| | - Frederic Brioude
- Universités, UPMC Univ Paris 06, Centre de Recherche St Antoine Inserm UMRS.938, APHP Hôpital Armand Trousseau Pediatric and Genetic Endocinology, 75012 Paris, France
| | - Linda Dainese
- Sorbonne Universités, UPMC Univ Paris 06, APHP Hôpital Armand Trousseau Pathology Department, Centre de Recherche St Antoine, Inserm UMRS.938, 75012 Paris, France
| | - Claire Cropet
- Université de Lyon - Centre Léon Bérard, Department of Statistics, 69008 Lyon, France
| | - Aurore Coulomb L'hermine
- Sorbonne Universités, UPMC Univ Paris 06, APHP Hôpital Armand Trousseau Pathology Department, Centre de Recherche St Antoine, Inserm UMRS.938, 75012 Paris, France
| | - Claudia Pasqualini
- Gustave Roussy Cancer Campus, Pediatric Oncology, 94800 Villejuif, France
| | - Frederic Auber
- Université de Bourgogne Franche-Comté, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA 4662, CHRU Besançon, Service de Chirurgie Pédiatrique, 25030 Besançon, France
| | - Arnauld Verschuur
- Department of Pediatric Hematology and Oncology, Hôpital de la Timone Enfant, 13005 Marseille, France
| | - Gudrun Schleiermacher
- Institut Curie, Paediatric oncology, 3 INSERM U830, Laboratoire de Génétique et Biologie des Cancers, 75005 Paris, France
| | - Yves Le Bouc
- Universités, UPMC Univ Paris 06, Centre de Recherche St Antoine Inserm UMRS.938, APHP Hôpital Armand Trousseau Pediatric and Genetic Endocinology, 75012 Paris, France
| | - Georges Audry
- Sorbonne Universités, UPMC Univ Paris 06, APHP Hôpital Armand Trousseau, Pediatric Surgery, 75012 Paris, France
| | - Sabine Irtan
- Sorbonne Universités, UPMC Univ Paris 06, APHP Hôpital Armand Trousseau Pediatric Surgery, Centre de Recherche St Antoine, Inserm UMRS.938, 75012 Paris, France
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Chen SH, Hung IJ, Yang CP, Jaing TH, Wang CJ, Hsueh C, Lai JY. Clinical features and long-term outcomes of bilateral Wilms tumor treated with Taiwan Pediatric Oncology Group protocols: A single center report. Asia Pac J Clin Oncol 2016; 12:300-7. [PMID: 27230630 DOI: 10.1111/ajco.12501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/22/2016] [Accepted: 04/05/2016] [Indexed: 12/01/2022]
Abstract
AIMS Wilms tumor (WT) is rare in Asia. Treatment of bilateral WT is challenging, and the treatment outcome of bilateral WT is rarely reported in low incidence areas. METHODS We enrolled patients with bilateral WT registered in Chang Gung Memorial Hospital, Taoyuan, Taiwan, between January 1986 and June 2015. They were treated according to the Taiwan Pediatric Oncology Group (TPOG) protocols. The clinical features and long-term outcomes were analyzed. RESULTS Six patients with histologically-proved bilateral WT were identified for analysis. One additional patient who was diagnosed with unilateral WT-associated intralobar nephrogenic rest, in addition to two small lesions in the contralateral kidney, was also included. There were total of three male patients and four female patients. The median follow-up period was 19 years (range 8-29 years). Five patients underwent initial biopsy and preoperative chemotherapy followed by surgery, whereas two patients underwent initial surgery followed by adjuvant chemotherapy. Local recurrence was found in two patients. The 8-year event-free survival and overall survival rates were 71.4% and 100%, respectively. Two patients developed advanced stage of chronic kidney disease, but none had been diagnosed with secondary malignant neoplasm. Other health issues such as hypertension, scoliosis and unspecified autoimmune disease were also found. CONCLUSIONS The treatment outcome in this study is comparably superior to other western countries. However, survivors of bilateral WT still have many chronic health issues and thereby need individualized long-term medical care.
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Affiliation(s)
- Shih-Hsiang Chen
- Division of Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Iou-Jih Hung
- Division of Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Ping Yang
- Division of Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Division of Pediatric Hematology/Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chao-Jan Wang
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Division of Pediatric Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Rabeh W, Akel S, Eid T, Muwakkit S, Abboud M, El Solh H, Saab R. Wilms tumor: Successes and challenges in management outside of cooperative clinical trials. Hematol Oncol Stem Cell Ther 2016; 9:20-5. [PMID: 26802622 DOI: 10.1016/j.hemonc.2015.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/01/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE/BACKGROUND Management of Wilms tumor (WT) in children depends on a multidisciplinary approach to treatment, and outcomes have significantly improved as reported by cooperative group clinical trials. Here, we review the clinical outcomes of patients with WT and identify challenges and barriers encountered in multidisciplinary management outside of cooperative clinical trials. METHODS We retrospectively reviewed the clinical records of 35 children with WT treated between April 2002 and June 2013 at the Children's Cancer Institute in Lebanon. RESULTS Upfront resection was performed in 23 cases. Biopsies were performed for Stage V tumors (n=4), those with unresectable tumors or inferior vena caval thrombus (n=5), and patients who had partial surgery performed elsewhere prior to presentation (n=2). One patient died due to toxicity prior to surgery. The tumor was Stage I in eight patients, Stage II in five patients, Stages III and IV in nine patients each, and bilateral (Stage V) in four patients. Adherence to The National Wilms Tumor Study-5 recommendations was adequate. At the time of analysis, 30 patients were free of disease and four patients had relapse-all having metastatic disease initially. CONCLUSION The National Wilms Tumor Study-5 therapy resulted in favorable outcomes in children with nonmetastatic Wilms tumor in the setting of a multidisciplinary approach to therapy and resolution of financial barriers to medical care. Upstaging due to prior intervention and lung radiation therapy to all those with computed tomography-detected lung nodules may both have resulted in overtreatment of a subset of patients. Finally, the relatively high incidence of bilateral tumors suggests the need for further genetic and molecular studies in this patient population.
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Affiliation(s)
- Wissam Rabeh
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samir Akel
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Toufic Eid
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samar Muwakkit
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Miguel Abboud
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hassan El Solh
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Raya Saab
- Children's Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.
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Overall Survival and Renal Function of Patients With Synchronous Bilateral Wilms Tumor Undergoing Surgery at a Single Institution. Ann Surg 2015; 262:570-6. [PMID: 26366536 DOI: 10.1097/sla.0000000000001451] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Wilms tumor is the most common renal cancer in children. Approximately 5% of children with Wilms tumor present with disease in both kidneys. The treatment challenge is to achieve a high cure rate while maintaining long-term renal function. We retrospectively reviewed our institutional experience with nephron sparing surgery (NSS) in patients with synchronous bilateral Wilms tumor (BWT) operated on between 2001 and 2014. METHODS Imaging studies, surgical approach, adjuvant therapy, and pathology reports were reviewed. Outcomes evaluated included surgical complications, tumor recurrence, patient survival, and renal function, as assessed by estimated glomerular filtration rate. RESULTS A total of 42 patients with BWT were identified: 39 (92.9%) patients underwent bilateral NSS; only 3 patients (7.1%) underwent unilateral nephrectomy with contralateral NSS. Postoperative complications included prolonged urine leak (10), infection (6), intussusception (2), and transient renal insufficiency (1). Three patients required early (within 4 months) repeat of NSS for residual tumor. In the long-term, 7 (16.7%) patients had local tumor recurrence (managed with repeat NSS in 6 and completion nephrectomy in 1) and 3 had an episode of intestinal obstruction requiring surgical intervention. Overall survival was 85.7% (mean follow-up, 4.1 years). Of the 6 patients who died, 5 had diffuse anaplastic histology. All of the patients had an estimated glomerular filtration rate more than 60 mL/min/1.73 m at the last follow-up; no patient developed end-stage renal disease. CONCLUSIONS In patients with synchronous, BWT, bilateral NSS is safe and almost always feasible, thereby preserving maximal renal parenchyma. With this approach, survival was excellent, as was maintenance of the renal function.
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Hubertus J, Günther B, Becker K, Graf N, Furtwängler R, Ferrari R, Gruhn B, Stahl R, von Schweinitz D, Stehr M. Development of Hypertension is Less Frequent after Bilateral Nephron Sparing Surgery for Bilateral Wilms Tumor in a Long-Term Survey. J Urol 2015; 193:262-6. [DOI: 10.1016/j.juro.2014.07.116] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Jochen Hubertus
- Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Brigitte Günther
- Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Kristina Becker
- Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, University of Saarland, Homburg/Saar, Germany
| | - Rhoikos Furtwängler
- Department of Pediatric Oncology and Hematology, University of Saarland, Homburg/Saar, Germany
| | - Rudolf Ferrari
- Department of Pediatric Oncology and Hematology, Gemeinschaftsklinikum Koblenz-Mayen, Koblenz, Germany
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Robert Stahl
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery, Research Laboratories, Ludwig-Maximilians-University of Munich, Munich, Germany
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Agarwala S, Mittal D, Bhatnagar V, Srinivas M, Bakhshi S, Bajpai M, Gupta DK, Iyer VK, Mohanti BK, Thulkar S. Management and outcomes in massive bilateral Wilms' tumors. J Indian Assoc Pediatr Surg 2014; 19:208-12. [PMID: 25336802 PMCID: PMC4204245 DOI: 10.4103/0971-9261.142005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: To evaluate the outcome of children with bilateral Wilms’ tumor (BWT) treated on All India Institute of Medical Sciences-Wilms Tumor-99 (AIIMS-WT-99) protocol. Materials and Methods: All children with BWT, registered in our solid tumor clinic from August 1999 through December 2010 were included. Results: Of the 178 fresh cases of Wilms Tumor (WT) treated during this period, 11 (6.2%) had bilateral involvement. All patients except one (12 and 3 cm), had massive bilateral tumors of more than 10 cm on each side. There were eight boys and three girls in the age range 6–30 months. One patient had Denys-Drash syndrome. Twenty renal units were operated upon (12 tumorectomy, five partial nephrectomy, and three nephrectomies), while one patient with inferior vena cava (IVC) thrombus died of renal failure. Tumor spill occurred in three units, lymphnode was positive in two patients. Local recurrence occurred in four patients (six of 18 renal units (33%)—two bilateral and two unilateral). There was one recurrence in the liver that was treated with radio-frequency ablation. The 5-year overall survival (OS) was 90% (95% confidence interval (CI) = 50.8–98.6) and the relapse free survival (RFS) was 38% (95% CI = 6.1–71.6). Conclusion: Massive BWT respond poorly to preoperative chemotherapy, are often not amenable to partial nephrectomy/tumorectomy and have a higher local recurrence rate, giving a poor RFS.
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Affiliation(s)
- Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Mittal
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - M Srinivas
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, BRAIRCH, AIIMS, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Gupta
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - V K Iyer
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sanjay Thulkar
- Department of Radiodiagnosis, BRAIRCH, AIIMS, New Delhi, India
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Oue T, Koshinaga T, Okita H, Kaneko Y, Hinotsu S, Fukuzawa M. Bilateral Wilms tumors treated according to the Japan Wilms Tumor Study Group protocol. Pediatr Blood Cancer 2014; 61:1184-9. [PMID: 24623612 DOI: 10.1002/pbc.24979] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/17/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND The introduction of multimodal therapy has improved the survival rate of bilateral Wilms tumors (BWT); however, the results are still not satisfactory in terms of the renal preservation. To establish a new treatment strategy for BWT, we reviewed the results of the cases registered in the Japan Wilms Tumor Study Group (JWiTS). PROCEDURE This analysis concerned patients with synchronous BWT registered in the JWiTS between 1996 and 2011. In these patients, the management of BWT included initial tumor resection or biopsy followed by chemotherapy. The details of the treatments and outcomes were analyzed. RESULTS Among the 355 cases registered in the JWiTS database, 31 (8.7%) had BWT. They were 16 males and 15 females with a mean age of 15.5 months. Preoperative chemotherapy was performed in 24 cases. Bilateral nephron-sparing surgery (NSS) was achieved in 10 of 28 cases (36%). All of the cases were of favorable nephroblastoma without anaplasia, and a WT1 mutation was detected in 21 of the 27 cases (78%) examined. The 5-year overall survival was 92.6%; however, 10 children (40%) developed impaired renal function and three of them developed renal failure. CONCLUSIONS The long-term survival rates for patients with synchronous BWT have improved. However, more than half of patients receive nephrectomy. The protocol should be changed to improve the rate of preservation of the renal parenchyma. Preoperative chemotherapy should be performed to shrink the tumors in every case, and subsequent NSS should be carried out after a central imaging evaluation.
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Affiliation(s)
- Takaharu Oue
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Abstract
Wilms tumor (WT) is the most common malignant renal tumor in childhood. Approximately 5-7% of WT patients present with bilateral disease, either synchronously or metachronously. Bilateral WT usually occurs in younger children and more often in girls. Management of a child with bilateral WT is very challenging. In contrast to unilateral WT, there has not been uniform agreement about the therapeutic strategy in the management of bilateral WT. As surgery is a critical component in the treatment of WT, the aim is to achieve a high cure rate while maintaining adequate long-term renal function in patients with bilateral WT. In the past, radical surgical procedures which lead to the patients on dialysis have been traditionally recommended in these patients. After several multicentre trials, bilateral biopsies followed by pre-operative chemotherapy and then renal salvage surgery have been recommended. The management of bilateral WT has evolved from primary surgical extirpation to kidney-preserving resection after preoperative chemotherapy. Preoperative chemotherapy often results in significant reduction in tumor size, thereby facilitating subsequent renal salvage. The analysis of children with bilateral WT shows that preservation of renal parenchyma is possible following initial preoperative chemotherapy. Only centers with experience in bilateral WT should treat the cases with bilateral WT to provide optimal treatment.
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Affiliation(s)
- Derya Özyörük
- 1 Pediatric Oncologist, Department of Pediatric Hematology Oncology, 2 Associate Professor of Pediatrics, Department of Pediatric Hematology Oncology, Ankara Children's Hematology Oncology Training and Research Hospital, Altındağ, Ankara, Turkey
| | - Suna Emir
- 1 Pediatric Oncologist, Department of Pediatric Hematology Oncology, 2 Associate Professor of Pediatrics, Department of Pediatric Hematology Oncology, Ankara Children's Hematology Oncology Training and Research Hospital, Altındağ, Ankara, Turkey
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Carmichael SP, Pulliam JF, D'Orazio JA. Delayed tumor resection in a 5-year-old child with bilateral Wilms tumor. J Surg Case Rep 2013; 2013:rjt012. [PMID: 24964423 PMCID: PMC3635223 DOI: 10.1093/jscr/rjt012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the case of a 5-year-old girl whose abdominal pain and distension were caused by Wilms tumor of the kidney. Because of the bilateral nature of her disease, she was spared biopsy or initial nephrectomy as part of her treatment course. Rather, she was treated presumptively for Wilms tumor based primarily on radiologic findings. Neoadjuvant chemotherapy consisting of vincristine, dactinomycin and doxorubicin was given to facilitate nephron-sparing surgery for tumor resection. Her initial chemotherapeutic course was complicated by tumor lysis syndrome manifested by elevated serum uric acid and was treated effectively with hyperhydration and alkalization of intravenous fluids. The patient's disease responded well to chemotherapy, and she underwent successful tumor excision after 12 weeks of chemotherapy. The resected tumor was identified as anaplastic Wilms tumor, illustrating that pathologic identification of Wilms tumor is possible even after multiple cycles of neoadjuvant chemotherapy and marked tumor shrinkage.
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Affiliation(s)
| | - Joseph F Pulliam
- Department of Pathology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - John A D'Orazio
- Department of Pediatrics (Hematology-Oncology) and the Markey Cancer Center, University of Kentucky College of Medicine, Lexington, KY, USA
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Indolfi P, Jenkner A, Terenziani M, Crocoli A, Serra A, Collini P, Biasoni D, Gandola L, Bisogno G, Cecchetto G, Di Martino M, D'Angelo P, Bianchi M, Conte M, Inserra A, Pession A, Spreafico F. Synchronous bilateral Wilms tumor: a report from the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP). Cancer 2013; 119:1586-92. [PMID: 23310931 DOI: 10.1002/cncr.27897] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/20/2012] [Accepted: 09/21/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND The optimal management of bilateral Wilms tumor (BWT) is challenging, and their survival is lower than for unilateral tumors. This report discusses a large series of BWTs treated in Italy in the last 2 decades. METHODS This analysis concerns patients with synchronous BWT registered at Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) centers between 1990 and 2011; details on their treatment and outcome are presented and discussed. RESULTS Ninety BWTs were registered in the AIEOP Wilms tumor database. Preoperative chemotherapy was given for a median 12 weeks before definitive tumor resection was attempted. Forty-eight percent of the patients had preservation of bilateral renal parenchyma. The proportion of bilateral nephron-sparing surgeries was not higher in the 37 patients initially given doxorubicin/vincristine/actinomycin D (32%) than in the 43 children receiving vincristine/actinomycin D alone (58%). The 4-year disease-free survival rate was 66.5% ± 5% and overall survival was 80% ± 5% for the cohort as a whole. The 4-year disease-free survival (overall survival) for 18 children with diffuse anaplasia or postchemotherapy blastemal-type tumors was 51% ± 13% (62% ± 13%), as opposed to 72% ± 3% (88% ± 4%) for 68 children with a favorable histology (log-rank P = .04 [P = .007]). CONCLUSIONS These results provide further evidence that the optimal duration and choice of drugs for preoperative chemotherapy remain an open question. Outcome remained significantly worse for BWT than for unilateral Wilms tumor. To enable the conservative treatment of as many affected kidneys as possible, only centers with experience in BWT should manage such cases.
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Affiliation(s)
- Paolo Indolfi
- Pediatric Oncology Unit, Department of Pediatrics, II University, Naples, Italy
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