Brain Metastases in Wilms Tumor: Case Report and Literature Review

Abstract

A 2-year-old girl who had a stage 2, favorable-histology Wilms tumor diagnosed when she was age 10 months presented with multiple brain metastases at second recurrence. She had been treated with combined radiotherapy, surgery, and chemotherapy; at 2 months after treatment, recurrent disease developed in the central nervous system and she died. Brain metastases are rare in the natural history of Wilms tumor. Although it does not appear that cerebral metastases are a barrier to tumor eradication and long-term survival if treated with combined modality therapy, treatment should be individualized.

Relapsed Wilms' tumor with multiple brain metastasis

“…Whole (30 Gy in 10 fractions) or local radiotherapy (30–36 Gy in 1.5–1.8 Gy fractions) to brain metastases are method of choices. A treatment regimen of vincristine, actinomycin D and cyclophosphamide were being used conveniently, however ifosfamide and etoposide have turned to be superior in terms of treatment success2). The patient we presented had one solid mass in the cerebellum and multiple small metastases in the whole brain.…”

“…There is also no consensus over treatment modality for brain metastases of Wilms' tumor. However, median survival is 1 month for untreated patients, and sole treatment with only surgery or only radiotherapy is not enough for a long survival time210111213). Whole (30 Gy in 10 fractions) or local radiotherapy (30–36 Gy in 1.5–1.8 Gy fractions) to brain metastases are method of choices.…”

“…Survival correlates with tumor histology, as children, with favorable tumor histology have good survival rates despite widespread disease (5-year survival rate is over 80%)3). Lung is the most common metastatic site thereafter liver, lymph nodes and bone2). We present a rare case of Wilms' tumor with multiple brain metastases harboring anaplastic features.…”

“…Wilms' tumor is the second most common solid neoplasm and the most common malignant renal tumor in childhood affecting 1/1,000 of children12). Survival correlates with tumor histology, as children, with favorable tumor histology have good survival rates despite widespread disease (5-year survival rate is over 80%)3).…”

Closure of patent foramen ovale: The abolition of stroke and asymptotic realities

“…The occurrence of brain metastases at relapse is a rare event in Wilms tumor patients. Until 1998 a few case reports and literature reviews were available which report a cumulative number of not more than 30 patients 4,12–23. Recently from the registration of large cohorts of patients like the UKCCSG data and the NWTSG 5,6 an incidence of CNS relapse in nephroblastoma patients was described of less than 1%.…”