Bilateral Wilms’ tumour: An international comparison of treatments and outcomes

Drysdale, Henry; Fawkner-Corbett, David; Solomon, Zubrina; Cundy, Olivia; Loveland, Jerome; Perrin, J; Lane, Rosemary; Price, Neil; Anyanwu, Lofty-John Chukwuemeka; Wilson, Shaun; Lakhoo, Kokila

doi:10.1016/j.jpedsurg.2021.01.040

Cited by 4 publications

(7 citation statements)

References 23 publications

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“…The available options for synchronous BWT include unilateral RN with contralateral NSS, bilateral NSS, or bilateral RN, and the most common surgical procedure is unilateral RN with contralateral NSS ( 1 ). Drysdale reviewed BWT from 4 centers and discovered that unilateral RN with contralateral NSS was the preferred option in low-income centers, whereas bilateral NSS was more prevalent in high-income centers ( 15 ). Presumably, patients in low-income centers may have a higher stage distribution.…”

Section: Discussionmentioning

confidence: 99%

Bench surgery with autotransplantation for bilateral Wilms tumor—A feasible technique for renal sinus invasion

Gao

Chen

et al. 2022

Front. Surg.

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PurposeBilateral 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 methodsIn 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.ResultsThe 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).ConclusionsIn 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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Section: Discussionmentioning

confidence: 99%

Bench surgery with autotransplantation for bilateral Wilms tumor—A feasible technique for renal sinus invasion

Gao

Chen

et al. 2022

Front. Surg.

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“…Compared to HIC, patients with WT in LMIC are diagnosed later, with higher tumor volume and stage 62 and an older age. [63][64][65] Malnutrition and poor clinical conditions due to advanced illness are common 66 and favor a higher incidence of severe treatment-related toxicities and deaths. 63,[67][68][69] The combination of poor clinical status at the time of diagnosis, shortage of essential medicines, high cost of treatment and transportation resulting in treatment abandonment or refusal, 67,[70][71][72] low treatment compliance, and utilization of inadequately intensive treatment including omission of RT negatively impact survival.…”

Section: High-risk Wilms Tumor In Low-and Low Middle-income Countriesmentioning

confidence: 99%

Advances in the clinical management of high‐risk Wilms tumors

Ortiz

Koenig

Armstrong

et al. 2023

Pediatric Blood & Cancer

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Outcomes are excellent for the majority of patients with Wilms tumors (WT). However, there remain WT subgroups for which the survival rate is approximately 50% or lower. Acknowledging that the composition of this high-risk group has changed over time reflecting improvements in therapy, we introduce the authors' view of the historical and current approach to the classification and treatment of high-risk WT. For this review, we consider high-risk WT to include patients with newly diagnosed metastatic blastemal-type or diffuse anaplastic histology, those who relapse after having been initially treated with three or more different chemotherapeutics, or those who relapse more than once. In certain low-or low middle-income settings, socio-economic factors expand the definition of what constitutes a high-risk WT. As conventional therapies are inadequate to cure the majority of high-risk WT patients, advancement of laboratory and early-phase clinical investigations to identify active agents is urgently needed.

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“…In view of this, the definition of high‐risk tumors in LMIC is largely influenced by nonclinical factors limiting timely access to integrated—when available—care (Table 4). Compared to HIC, patients with WT in LMIC are diagnosed later, with higher tumor volume and stage 62 and an older age 63–65 . Malnutrition and poor clinical conditions due to advanced illness are common 66 and favor a higher incidence of severe treatment‐related toxicities and deaths 63,67–69 .…”

Section: High‐risk Wilms Tumor In Low‐ and Low Middle‐income Countriesmentioning

confidence: 99%

Section: High-risk Wilms Tumor In Low-and Low Middle-income Countriesmentioning

confidence: 99%

“…63,[67][68][69] The combination of poor clinical status at the time of diagnosis, shortage of essential medicines, high cost of treatment and transportation resulting in treatment abandonment or refusal, 67,[70][71][72] low treatment compliance, and utilization of inadequately intensive treatment including omission of RT negatively impact survival. 64,70 LMICs report a higher proportion of patients with anaplasia and advanced disease, which correlate with poor prognosis. 68,70,73,74 However, the prevalence of high-risk factors may be underestimated in LMICs due to difficult access to standardized diagnostic studies like CT scans, which reduce the accuracy of staging and surgical planning.…”

Section: High-risk Wilms Tumor In Low-and Low Middle-income Countriesmentioning

confidence: 99%

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Advances in the clinical management of high‐risk Wilms tumors

Ortiz

Koenig

Armstrong

et al. 2023

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Outcomes are excellent for the majority of patients with Wilms tumors (WT). However, there remain WT subgroups for which the survival rate is approximately 50% or lower. Acknowledging that the composition of this high‐risk group has changed over time reflecting improvements in therapy, we introduce the authors’ view of the historical and current approach to the classification and treatment of high‐risk WT. For this review, we consider high‐risk WT to include patients with newly diagnosed metastatic blastemal‐type or diffuse anaplastic histology, those who relapse after having been initially treated with three or more different chemotherapeutics, or those who relapse more than once. In certain low‐ or low middle‐income settings, socio‐economic factors expand the definition of what constitutes a high‐risk WT. As conventional therapies are inadequate to cure the majority of high‐risk WT patients, advancement of laboratory and early‐phase clinical investigations to identify active agents is urgently needed.

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Bilateral Wilms’ tumour: An international comparison of treatments and outcomes

Cited by 4 publications

References 23 publications

Bench surgery with autotransplantation for bilateral Wilms tumor—A feasible technique for renal sinus invasion

Bench surgery with autotransplantation for bilateral Wilms tumor—A feasible technique for renal sinus invasion

Advances in the clinical management of high‐risk Wilms tumors

Advances in the clinical management of high‐risk Wilms tumors

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