Renal salvage procedures in patients with synchronous bilateral Wilms' tumors: A report from the National Wilms' Tumor Study Group

Horwitz, Jeffrey R.; Ritchey, Michael L.; Moksness, Jami; Breslow, Norman E.; Smith, Glenda L.; Thomas, Patrick R.; Haase, Gerald M.; Shamberger, Robert C.; Beckwith, J. Bruce

doi:10.1016/s0022-3468(96)90077-9

Cited by 120 publications

(72 citation statements)

References 30 publications

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“…Extended follow-up of patients with bilateral Wilms' tumor who were enrolled on NWTS-2 and -3 showed no difference in survival rates between those treated initially with surgical resection and those treated with biopsy and preoperative chemotherapy [57]. On NWTS-4, the risk of local recurrence for patients who underwent kidney-sparing resection was 8.2% [58]. The NWTS-5 recommendation for the management of bilateral Wilms' tumor includes initial biopsy and local staging followed by chemotherapy (according to abdominal stage and histologic features) and second-look surgery at week 5 [59].…”

Section: Treatment Of Bilateral Wilms' Tumormentioning

confidence: 99%

Current Therapy for Wilms’ Tumor

2005

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Section: Treatment Of Bilateral Wilms' Tumormentioning

confidence: 99%

Current Therapy for Wilms’ Tumor

2005

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“…Since then, several studies have confirmed the beneficial effects of preoperative chemotherapy followed by conservative surgical resection in patients with amenable, favorable histology, bilateral Wilms tumors [14][15][16]. 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].…”

Section: Discussionmentioning

confidence: 97%

“…These children receive preoperative chemotherapy with the goal of tumor shrinkage and then undergo nephron (renal) sparing surgery (NSS) [2,] . 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].…”

Section: Introductionmentioning

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%

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Nephron Sparing Surgery for Unilateral Non-Syndromic Wilms Tumor

Nerli

Pujar

Hiremath

et al. 2014

Indian J Surg Oncol

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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.

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“…While nephron-saving surgery leads to the possibility of positive margins, which causes concern for potentially higher recurrence rates from an oncological standpoint, it was shown that positive surgical margins do not invariably lead to local recurrence [15], reflecting the chemosensitivity and radiosensitivity of Wilm's tumor. Rather, the ability to leave the patient with functioning renal parenchyma in those with favorable histology BWT has given physicians the opportunity to maintain cure rates without sacrificing overall renal function.…”

Section: Discussionmentioning

confidence: 99%

Management of Bilateral Wilms’ Tumor: Our Experience

Raghunath

Jadhav

Shankar

et al. 2016

Indian J Surg Oncol

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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.

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Renal salvage procedures in patients with synchronous bilateral Wilms' tumors: A report from the National Wilms' Tumor Study Group

Cited by 120 publications

References 30 publications

Current Therapy for Wilms’ Tumor

Current Therapy for Wilms’ Tumor

Nephron Sparing Surgery for Unilateral Non-Syndromic Wilms Tumor

Management of Bilateral Wilms’ Tumor: Our Experience

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