Wilm's tumor: A 25-year review of the role of preoperative chemotherapy

• Published in: Journal of pediatric surgery Vol. 34; no. 4; pp. 579 - 582
• Main Authors: Capra, M.L., Walker, D.A., Mohammed, Wan M.W., Kapila, L., Barbor, P.R.H., Sokal, M., Robson, K., Hewitt, M., Stewart, R.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.04.1999; Elsevier
• Subjects: Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Chemotherapy; Chemotherapy, Adjuvant; Child; Child, Preschool; Female; Humans; Infant; Kidney - pathology; Kidney Neoplasms - drug therapy; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Medical sciences; Neoplasm Staging; Pharmacology. Drug treatments; Randomized Controlled Trials as Topic; Retrospective Studies; Survival Rate; Time Factors; Wilms Tumor - drug therapy; Wilms Tumor - mortality; Wilms Tumor - pathology; Wilms Tumor - surgery; preoperative chemotherapy; Wilms' tumor; histological staging; Human; Kidney disease; Antineoplastic agent; Chemotherapy; Urinary system disease; Wilms tumor; Influence; Malignant tumor; Preoperative; Child; Morbidity; Bibliographic review
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(99)90078-7

Purpose : This 25-year population based, single institution review was conducted to investigate the impact of preoperative chemotherapy on surgical and histological staging in patients with Wilms' tumors. Results : Forty-nine patients under the age of 15 years were identified from case notes to have had histologically verified Wilms' tumors over the 25-year period from January 1972 to December 1996. Twenty-six patients were treated initially with preoperative chemotherapy, 23 with immediate surgery. Eleven had treatment randomized within the UKCCSG WT9101 trial (UKWT3), and the remainder received initial treatment according to unit policy. Surgical stages in the two groups (preoperative chemotherapy and immediate surgery) were respectively, stage 1: 14 (28.5%) and 11 (22.5%), stage II: one (2%) and eight (16.3%), stage III: 11 (22.5%) and four (8.2%). Seven patients had clinical stage IV disease at presentation. Histology results were favorable in 45 patients and unfavorable in four. All patients received chemotherapy during treament, whereas 25 (51%) also received radiotherapy. No significant difference was evident in the two groups with respect to treatment-related morbidity. Five patients relapsed, three of whom died within the period of review, but a fourth has since died. Conclusions : This study suggests that the use of preoperative chemotherapy does not put the patient at increased risk of postoperative morbidity or reduced survival. The distribution of surgical stages suggests that limited tumor downstaging may have occurred as a result of preoperative chemotherapy.