Surgical implications for liver metastases in nephroblastoma—Data from the SIOP/GPOH study

Fuchs, Joerg; Szavay, Philipp; Luithle, Tobias; Furtwängler, Rhoikos; Graf, Norbert

doi:10.1016/j.suronc.2007.08.011

Cited by 17 publications

(31 citation statements)

References 23 publications

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“…Our metastatic response rate after preoperative chemotherapy is similar to previously reported data, where liver metastasis responded to “chemotherapy only” in 14% of the cases, 18 and in our cohort we confirmed its impact on outcome. Among the three patients in CR at the time of nephrectomy, only one received lung RT, and they all survived without progression.…”

Section: Discussionsupporting

confidence: 92%

Liver metastasis at diagnosis in children with nephroblastoma enrolled in SIOP2001 protocol: A French multicentric study

Liné

Sudour-Bonnange

Languillat-Fouquet

et al. 2020

Pediatric Blood & Cancer

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Background: Liver metastases are rare in children with Wilms tumor (WT), and their impact on the outcome is unclear. Patients and methods:The French cohort of patients with WT presenting liver metastases at diagnosis and enrolled in the International Society of Pediatric Oncology (SIOP) 2001 study was reviewed.Results: From 2002 to 2012, 906 French patients were enrolled in the SIOP2001 trial. Among them, 131 (14%) presented with stage IV WT and 18 (1.9%) had liver metastases at diagnosis. Isolated liver metastases were displayed in four of them. After preoperative chemotherapy, persistent liver disease was reported in 14/18 patients, and 13 of them underwent metastasectomy after nephrectomy. In resected liver lesions, the same histology of the primary tumor was reported for three patients, blastemal cells without anaplasia were identified in one patient with DA-WT, and post-chemotherapy necrosis/fibrosis was identified for the other 10 patients. For the four patients who had liver and lung surgery, both sites had nonviable cells with post-chemotherapy necrosis/fibrosis. Six patients had hepatic radiotherapy. Sixteen patients achieved primary complete remission and were alive at the last follow-up (median follow-up: 6.4 years). The only two deceased patients presented diffuse anaplasia histology. The five-year EFS and OS were 83% (60%-94%) and 88% (66%-97%), respectively. Conclusion:Liver involvement does not appear to be an adverse prognostic factor in metastatic WT. The role of hepatic surgery and radiotherapy remains unclear, and should be carefully considered in case of persistent liver metastases, according to histology and radiological response to other metastatic sites. K E Y W O R D Sclinical trials, liver metastasis, pediatric oncology, renal tumor, solid tumors, tumors, Wilms tumor

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Section: Discussionsupporting

confidence: 92%

Liver metastasis at diagnosis in children with nephroblastoma enrolled in SIOP2001 protocol: A French multicentric study

Liné

Sudour-Bonnange

Languillat-Fouquet

et al. 2020

Pediatric Blood & Cancer

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“…2–5 Recent reports, however, suggested that liver involvement at diagnosis in infants and children with Wilms tumor indicated a worse prognosis than lung or other sites of Stage IV disease. 6–8 The International Society of Pediatric Oncology (SIOP) and the German Pediatric Oncology Group (GPOH) studied 29 patients with liver metastases at diagnosis, including some adult patients with Wilms tumor. 7 The overall survival was less than 60%, but all patients who had complete resection of the hepatic lesions survived.…”

Section: Introductionmentioning

confidence: 99%

Hepatic Metastasis at Diagnosis in Patients With Wilms Tumor is not an Independent Adverse Prognostic Factor for Stage IV Wilms Tumor

Ehrlich¹,

Ferrer²,

Ritchey³

et al. 2009

Annals of Surgery

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Objective To determine event free survival (EFS) of children with Wilms tumor (WT) and metastatic liver disease at diagnosis. Summary and Background data We reviewed patients with stage IV Wilms tumor treated on National Wilms Tumor Study 4 and -5 to ascertain if they have a worse prognosis than other Stage IV disease. Methods 742 patients (pts) with stage IV disease were assessed for EFS (95% confidence interval [CI]) at 5 years after diagnosis. Cohorts included those who underwent resection of the liver lesions compared with those who received only chemotherapy and radiotherapy (XRT). Results Seven hundred and forty two patients with stage IV Wilms tumor were enrolled on NWTS-4 and 5, 111 of who had liver metastases. Of these, 96 had favorable histology disease and are the focus of this analysis. Twenty-two patients had a primary liver resection (wedge resection - 18 and lobectomy – 4). After chemotherapy and/or radiation, 13 patients underwent liver resection (wedge resection - 7, lobectomy - 5 and trisegmentectomy – 1). Seventy-one patients (67%) did not undergo surgery for their liver disease. In 14 patients the liver disease disappeared with chemotherapy only. Eighty-two patients received abdominal radiation. EFS for the patients with metastatic FH Wilms tumor was 75% (95% confidence interval [CI]: (71%, 78%), EFS by Stage IV category was: lung only 76% (95% CI: 72%, 80%)(513 patients); liver, not lung 76% (95% CI: 58%, 87%)(34 patients); liver and lung 70% (95% CI: 57%, 80%)(62 patients) and other sites 64% (95% CI: 42%, 79%)(25 patients). There were no significant differences among stage IV groups (p=0.60). EFS (95% CI) for the patients with primary resection of the liver metastases (22 patients) was 86% (63%, 95%) compared to 68% (56%, 78%) (p=0.09) for the 74 with no primary resection of liver metastases. There was no significant difference in EFS for patients with FH Wilms tumor treated with chemotherapy compared to that of patients treated with chemotherapy and radiation (p=0.63). The EFS (95% CI) for each of the subsets was; no abdominal radiation: 64% (34%, 83%); abdominal radiation, no boost: 77% (55%, 89%); abdominal radiation, boost: 72% (58%, 82%) (p=0.05). Conclusion Liver metastasis at diagnosis is not an adverse prognostic factor for stage IV metastatic FH WT.

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“…Interestingly patients having had metastatic PD had a marked increase of survival from 48 % to 65 -75 % over time. 2 recent reports suggest a positive impact of complete surgical resection in lung [6] and liver [7] metastasis in these patients. Hence the tendency to more aggressive local surgical treatment of liver and lung metastasis might have infl uenced the outcome positively.…”

Section: Risk Factorsmentioning

confidence: 90%

“…Introduction ▼ Over the last 2 decades virtually all nephroblastoma-patients from Austria, eastern Switzerland and Germany have been treated according to the consecutive SIOP9 / GPO (1989 -1994), SIOP93-01 / GPOH (1994 -2002) and SIOP2001 / GPOH ( > 2001) trials. Results concerning fi rst line treatment are published in parts [5,7,22,29] . Vincristine, dactinomycin and doxorubicin have been classic fi rst line agents for more than 3 decades.…”

Section: Update On Relapses In Unilateral Nephroblastoma Registered Imentioning

confidence: 99%

Update on Relapses in Unilateral Nephroblastoma Registered in 3 Consecutive SIOP/GPOH Studies - A Report from the GPOH-Nephroblastoma Study Group

et al. 2011

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Surgical implications for liver metastases in nephroblastoma—Data from the SIOP/GPOH study

Cited by 17 publications

References 23 publications

Liver metastasis at diagnosis in children with nephroblastoma enrolled in SIOP2001 protocol: A French multicentric study

Liver metastasis at diagnosis in children with nephroblastoma enrolled in SIOP2001 protocol: A French multicentric study

Hepatic Metastasis at Diagnosis in Patients With Wilms Tumor is not an Independent Adverse Prognostic Factor for Stage IV Wilms Tumor

Update on Relapses in Unilateral Nephroblastoma Registered in 3 Consecutive SIOP/GPOH Studies - A Report from the GPOH-Nephroblastoma Study Group

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