Renal failure in Wilms' tumor patients: A report from the National Wilms' Tumor Study Group

Ritchey, Michael L.; Green, Daniel M.; Thomas, Patrick R.; Smith, Glenda L.; Haase, Gerald M.; Shochat, Stephen J.; Moksness, Jami; Breslow, Norman E.

doi:10.1002/(sici)1096-911x(199602)26:2<75::aid-mpo1>3.0.co;2-r

Cited by 201 publications

(98 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Partial nephrectomy was allowed only if the tumor involved one pole and less than one third of the kidney, if the patient had a functioning kidney, if the collecting system or renal vein had no tumor involvement, and if clear margins existed between the tumor and surrounding structures. Because the rate of renal failure in patients with unilateral Wilms' tumor is less than 1% [41], kidney-sparing resection is not generally recommended.…”

Section: The Nwtsg Experiencementioning

confidence: 99%

Current Therapy for Wilms’ Tumor

2005

View full text Add to dashboard Cite

Section: The Nwtsg Experiencementioning

confidence: 99%

Current Therapy for Wilms’ Tumor

2005

View full text Add to dashboard Cite

“…This demonstrates that pre-operative chemotherapy allows tumor shrinkage, leading to easier resection with preservation of unaffected parenchyma as well as decreased tumor spillage. This approach has resulted in an overall decrease in the incidence of renal failure in BWT, as evidenced by the fact that the renal failure rate in NWTS-1 and NWTS-2 was 16.4 % compared with 3.8 % in NWTS-4 [4].…”

Section: Discussionmentioning

confidence: 99%

“…Recent reports from NWTS indicate that the incidence of renal failure in patients with bilateral Wilms' tumor without associated anomalies is 11.5 at 20 years [3], the most common cause being the need for bilateral nephrectomy for persistent or recurrent tumor in the remaining kidney after initial nephrectomy [4]. A lot of literature regarding the role of nephron-sparing surgery in the management of BWT is available, but none from India so far [1][2][3][4][5]. We would like to share our small experience in the management of these children.…”

Section: Introductionmentioning

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

“…Appoximately 5 % to 7 % of these patients will have disease in both kidneys [9]. Several studies have demonstrated that patients with bilateral Wilms tumor are at risk for developing renal failure [10][11][12]. A review from the National Wilms Tumor Study Group (NWTSG) indicated that, among patients who had unilateral Wilms tumor without genitourinary abnormalities, Denys-Drash syndrome, or Wilms tumor-aniridia-genitourinary abnormality-mental retardation (WAGR) syndrome, the cumulative incidence of renal failure was only 0.6 %.…”

Section: Discussionmentioning

confidence: 99%

“…This is probably due to mutation of WT1, which is necessary for normal development [1]. The exact etiology of renal failure is not always clear and is likely to be multifactorial, with contributing factors including intrinsic, progressive renal disease related to a genetic predisposition, inadequate renal parenchyma after one or more tumor resections, the nephrotoxic effects of chemotherapy and radiation, and the potential for hyperfiltration injury to the remaining renal parenchyma [4,11].…”

Section: Discussionmentioning

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

Renal failure in Wilms' tumor patients: A report from the National Wilms' Tumor Study Group

Cited by 201 publications

References 25 publications

Current Therapy for Wilms’ Tumor

Current Therapy for Wilms’ Tumor

Management of Bilateral Wilms’ Tumor: Our Experience

Nephron Sparing Surgery for Unilateral Non-Syndromic Wilms Tumor

Contact Info

Product

Resources

About