Conservative Surgical Management of Bilateral Wilms Tumor: Results of the United Kingdom Children's Cancer Study Group

Kumar, Rajendra; Fitzgerald, Ray; Breatnach, Fin

doi:10.1016/s0022-5347(01)62588-6

Cited by 59 publications

(37 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 1979, NWTS-3 formally recommended initial biopsy and chemotherapy before surgical resection of bilateral tumors [6]. Since that time, multiple studies have confirmed the beneficial effects of neo-adjuvant chemotherapy followed by conservative surgical resection in amenable, favorable histology BWT cases [7,8]. This demonstrates that pre-operative chemotherapy allows tumor shrinkage, leading to easier resection with preservation of unaffected parenchyma as well as decreased tumor spillage.…”

Section: Discussionmentioning

confidence: 99%

Management of Bilateral Wilms’ Tumor: Our Experience

Raghunath

Jadhav

Shankar

et al. 2016

Indian J Surg Oncol

View full text Add to dashboard Cite

Management of bilateral Wilms' tumor is particularly challenging, considering the chances of recurrence and long-term renal function for affected patients. Aggressive surgical resection to prevent recurrence must be balanced with the desire to preserve renal function. We evaluated our experience in the management of bilateral Wilms' tumor stressing the challenges encountered in decision making and the role of nephron sparing surgery. We had four children presenting with bilateral Wilms' tumor. All of them were appropriately staged and given standard chemotherapy as per NWTS-5 guidelines. Tumors were considered to have a 'good' response to chemotherapy if sufficient tumor shrinkage was observed so that renal hilum was seen free of tumor and vice versa. Nephron-sparing surgery was considered in all and was performed when feasible, followed by completion adjuvant chemotherapy. All patients were followed up with serial ultrasound scans (3-6 monthly) and CECT abdomen (yearly once). Blood urea and serum creatinine, hypertension, and proteinuria were assessed during follow-up visits. All four children received neo-adjuvant chemotherapy as per NWTS-5 guidelines. The first child had poor response to chemotherapy and was considered for left radical and right partial nephrectomy. However, patient attenders refused any surgical intervention and the child was taken home. The second child had a 'good' response on left side and was planned for left partial and right radical nephroureterectomy based on pre-operative imaging analysis. However, intra-operatively, bilateral partial nephrectomy with good margins was feasible. The third child though, showed 'poor' response to pre-op chemotherapy and warranted bilateral nephroureterectomy, right partial and left radical nephroureterectomy was feasible. However, in the fourth child, we were not able to perform nephron sparing surgery and left nephroureterectomy with right tumor biopsy was done. Following this, child was started on 2nd-line chemotherapy, now awaiting right partial nephrectomy. The second child is on follow up for 1.5 years, doing well. However, the third child expired 1.5 years following surgery due to recurrence (lung metastasis). Management of bilateral Wilm's tumor is challenging and nephron-sparing surgery should be considered in all patients having bilateral Wilm's tumor with favorable histology, even if pre-operative imaging studies suggest that the lesions are unresectable.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of Bilateral Wilms’ Tumor: Our Experience

Raghunath

Jadhav

Shankar

et al. 2016

Indian J Surg Oncol

View full text Add to dashboard Cite

show abstract

“…In the NWTS-4, 36 of 186 patients (19.4 %) with synchronous, bilateral Wilms tumors underwent bilateral nephron-sparing procedures [17]. Other smaller series have reported performing bilateral nephron-sparing procedures in from 30 to 70 % of patients with bilateral Wilms tumors [2,14,18]. Davidoff et al [19] reported on the feasibility and outcome of nephron sparing surgery (NSS) in ten children with bilateral Wilms tumor.…”

Section: Discussionmentioning

confidence: 99%

“…Preservation of renal tissue is important to decrease the incidence of renal failure, which approaches 15 % at 15 years post-treatment in patients with bilateral Wilms tumor [3,4]. Currently unilateral Wilms tumor associated with predisposing syndromes are treated with a strategy that mirrors the approach followed for children with bilateral tumors or neoplasms arising in a solitary kidney [2][3][4]. However several centers, have also explored the role of Nephron-sparing procedures in children with unilateral non-syndromic Wilms tumors [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Nephron Sparing Surgery for Unilateral Non-Syndromic Wilms Tumor

Nerli

Pujar

Hiremath

et al. 2014

Indian J Surg Oncol

View full text Add to dashboard Cite

The initial therapy for most children with Wilms tumor is radical nephrectomy. Several centers, have explored the role of Nephron-sparing procedures in children with unilateral non-syndromic Wilms tumors. The primary motivation for this approach is concern about late occurrence of renal dysfunction after unilateral nephrectomy. We report our experience with NSS for unilateral non-syndromic Wilms tumor. We reviewed the records of nine children who underwent nephron sparing surgery for unilateral, nonsyndromic Wilms tumors at our Hospital between Jan 2000 through Jan 2012. All patients received preoperative chemotherapy with two drugs (vincristine, and dactinomycin) following which patients underwent tumor resection. Subsequent renal function was assessed by estimating the glomerular filtration rate using creatinine clearance and other measures of long-term renal function assessment included blood pressure evaluation and the need for antihypertensive medications. During the study period nine children with a mean age 19.66±14.37 months at diagnosis and presenting with unilateral non-syndromic Wilms tumor underwent nephron sparing surgery. In all the nine children, the renal plane of resection showed a tumor-free margin. Post-operative serum creatinine repeated at the end of 3 months revealed maintenance of good renal function in all children. Nephron sparing surgery is a safe and effective option in the management of early stage unilateral non-syndromic Wilms tumor. It is oncologically safe and does not lead to decreased local tumor control. The function of the kidney remnant remains rather well.

show abstract

“…Previous protocols allowed for primary resection of tumours followed by chemotherapy. While the overall survival in a study by the United Kingdom Children's Cancer Study Group was similar in those undergoing primary surgery followed by chemotherapy and those treated with neoadjuvant chemotherapy followed by surgery, the incidence of renal failure was 20% in the initial surgery group versus 6% in the initial chemotherapy group (26).…”

Section: Managementmentioning

confidence: 94%

Management of Bilateral Wilms Tumours

2016

View full text Add to dashboard Cite

Licence: This open access article is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Users are allowed to share (copy and redistribute the material in any medium or format) and adapt (remix, transform, and build upon the material for any purpose, even commercially), as long as the authors and the publisher are explicitly identified and properly acknowledged as the original source. AbstractSynchronous bilateral Wilms tumours (BWTs) represent 4% to 7% of all Wilms tumours (WTs) and present at a younger age than unilateral WTs do. At least 10% of synchronous BWTs have unfavourable histology, and up to 22% are associated with genitourinary abnormalities, aniridia, WAGR (WT, aniridia, genitourinary anomalies, and retardation) syndrome, Denys-Drash syndrome, hemihypertrophy or one of the other overgrowth syndromes. The long-term disease-free survival rate of patients with unilateral WT is now approaching 90% and is around 70% for those with metastatic disease. For both synchronous and metachronous WTs, the prognosis is less favourable, with reported cure rates 62approaching 80% in the best centres but are often considerably less in resource-poor settings. Also, there is the potential for a reduced quality of life due to renal insufficiency and the possible need for renal transplantation. Thus, the major clinical challenge in BWTs is the preservation of functioning renal tissue, while achieving cure with the minimum of therapyrelated morbidity. Although mortality is generally associated with progressive disease of anaplastic tumours, the emphasis of management has been increasingly placed on nephronsparing surgical approaches in an attempt to reduce ultimate renal insufficiency. 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 fear of long-term radiation injury to the residual functioning renal mass. Patient selection, appropriate pre-and post-operative chemotherapy, and skilful surgical techniques all contribute to excellent outcomes, where these are achievable.

show abstract

Conservative Surgical Management of Bilateral Wilms Tumor: Results of the United Kingdom Children's Cancer Study Group

Abstract: Conservative surgical treatment of favorable histology bilateral Wilms tumor may improve the preservation of renal mass and function without impairing patient survival.

Cited by 59 publications

References 18 publications

Management of Bilateral Wilms’ Tumor: Our Experience

Management of Bilateral Wilms’ Tumor: Our Experience

Nephron Sparing Surgery for Unilateral Non-Syndromic Wilms Tumor

Management of Bilateral Wilms Tumours

Contact Info

Product

Resources

About