Timing of adjuvant chemotherapy after laparotomy for Wilms tumor and neuroblastoma

Abstract

Purpose: To describe the timing of chemotherapy initiation after surgery for Wilms tumor (WT) and neuroblastoma within a dedicated children’s cancer center. Methods: A single-institution retrospective cohort study identified patients that underwent resection of unilateral WT or high-risk neuroblastoma and received adjuvant chemotherapy treatment. Adjuvant chemotherapy initiation and postoperative complications were recorded. Results: Among 47 WT patients, the median time to chemotherapy initiation was 11 days [interquartile range IQR 7-14]. 3 WT patients had post-operative complications, but all preceded chemotherapy. Among 83 patients treated for high-risk neuroblastoma, the median time to chemotherapy was 11 days [IQR 9-14]. High-risk neuroblastoma patients with 30-day postoperative complications had a significantly longer time to initiation of adjuvant chemotherapy (odds ratio 1.13; p=0.008). Many of these complications preceded and delayed the initiation of post-operative chemotherapy. No complications occurred in the group of 12 (25%) WT patients or 16 (19.3%) neuroblastoma patients who started chemotherapy ≤7 days after surgery. Conclusion: There is no association between early initiation of adjuvant chemotherapy and post-operative complications including wound healing. Early initiation of chemotherapy (≤7 days) is feasible in unilateral WT or high-risk neuroblastoma patients who are otherwise doing well without resulting in a preponderance of wound healing complications.

Relationship between the timing of chemotherapy and surgical complications following surgical biopsy in children with malignant solid tumors

“…In contrast, some studies have stated that early postoperative chemotherapy does not increase surgical complications 2,3 . Ross et al.…”

“…Ross et al. reported that adjuvant chemotherapy within 7 days after laparotomy for Wilms tumor and nephroblastoma was feasible 2 . The timing of adjuvant chemotherapy for Wilms tumor in the fifth National Wilms Tumor Study (NWTS‐5) protocol, in which the treatment is initiated within 5 days after nephrectomy, 12 is short compared with other protocols.…”

“…Chemotherapy should be initiated as soon as the diagnosis is confirmed; however, as wound healing is delayed by chemotherapy, 1 concerns remain that initiating chemotherapy after surgical procedures may lead to surgical complications. Some studies have reported that early initiation of chemotherapy following curative resection did not increase the rate of surgical complications, 2,3 but the ideal interval between biopsy and chemotherapy remains unclear. Particularly, pediatric malignant solid tumor is often bulky and symptomatic; therefore, early initiation of chemotherapy should be considered as soon as diagnosis is confirmed.…”

Identification of a 12-Gene Signature and Hub Genes Involved in Kidney Wilms Tumor via Integrated Bioinformatics Analysis

“…The treatment of nephroblastoma continues to be based on surgical resection supplemented by a combination of chemotherapy and radiotherapy ( 7 , 8 ). However, treatment-related complications remain a problem for many children with WT, with treatment often triggering nausea and vomiting, loss of appetite, anemia, alopecia, and neutropenia, which subsequently affect patients’ psychological well-being ( 9 ). At the same time, surgical removal of the diseased kidney has limitations.…”

quickBAM: a parallelized BAM file access API for high throughput sequence analysis informatics

“…However, the analysis turnaround is of critical importance. For example, it is the longstanding standard of care practice to initiate definitive therapy within 2 to 4 weeks after pediatric cancer patients receive biopsy / resection surgery (Ross et al 2021). Furthermore, after the optimal treatment is identified, it still takes significant time to coordinate treatment access due to e.g.…”