Understanding the principles in management of Wilms' tumour: Can imaging assist in patient selection?

Kembhavi, Seema; Qureshi, Sajid; Vora, Tushar; Chinnaswamy, Girish; Laskar, Siddhartha; Ramadwar, Mukta; Arora, Brijesh

doi:10.1016/j.crad.2012.11.012

Cited by 21 publications

(16 citation statements)

References 30 publications

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“…While most features mentioned above are not hard to evaluate for a radiologist, one could rightly argue that imaging cannot accurately depict the capsule of the kidney and hence cannot determine capsular invasion. Moreover, in children, retroperitoneal and perinephric fat is often sparse . To circumvent these problems, tumors with circumscribed smooth margins all around the surface of the tumor on all three planes were assumed to be intracapsular while lobulations on the tumor surface or indistinct margins with retroperitoneal organs or a bare area of liver or spleen were considered to have a suspicion of perinephric spread (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…The imaging features most likely associated with the risk of spillage or incomplete removal, such as extension of tumor across the midline, suspicion of perinephric spread or adjacent organ infiltration, presence of intravascular thrombus (even if only in the renal vein), presence of ureteric extension, and extensive retroperitoneal adenopathy (significant nodes that were encasing the retroperitoneal vessels) were defined as high-risk features (Figures 1 and 2) and utilized for deciding the initial treatment approach. 8 Upfront nephrectomy was performed in the absence of all of these high-risk features. Presence of any one or more of the above- While only a single radiologist reported the scans of a given patient for enrollment on the study, a post hoc analysis was also performed to look for concordance between two radiologists to assess interobserver variation in identifying the high-risk features at baseline scan.…”

Section: Methodsmentioning

confidence: 99%

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Customized approach for upfront or delayed resection using radiological criteria in unilateral, nonmetastatic pediatric renal tumors: A prospective study

Qureshi

Kembhavi

Bhagat

et al. 2019

Pediatric Blood & Cancer

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Background The availability of robust, equivalent data regarding outcomes for upfront or delayed surgery for renal tumors in children leads to a dilemma in selecting the initial treatment. Imaging criteria associated with the probability of rupture or incomplete resection may provide a more objective assessment for customization for the timing of surgery. Procedure Eighty‐three children with unilateral, nonmetastatic renal tumors were enrolled between January 2012 and April 2018. Upfront nephrectomy was performed in the absence or delayed surgery (after a biopsy and chemotherapy) in the presence of one or more imaging‐based high‐risk features, including perinephric spread or adjacent organ infiltration, tumors crossing the midline, intravascular thrombus, and extensive adenopathy. Post hoc analysis for interobserver concordance for high‐risk imaging features was also performed. Results The upfront surgery group (19) had predominantly stage I or II diseases (89%) and the histological types were Wilms (13), non‐Wilms (5) renal tumor, and an inflammatory lesion. The delayed surgery group had 60% with stage I or II diseases and the histological types were Wilms (60) and non‐Wilms (4) tumor. In addition, high‐risk pathology was identified in nine patients. Overall, 27 patients with Wilms tumors required radiotherapy and anthracycline because of stage III disease, including one in the immediate surgery group. The event‐free and overall survival (OS) at a median follow‐up of 39 months for Wilms tumor are 88% (95% confidence interval [CI]: 78.5‐94.9%) and 89% (95% CI: 81.4‐96.6%), 85.1% (95% CI: 73.8‐93.4%) and 86.5% (95% CI: 77.4‐95.8%) for the delayed, and 100% event‐free survival as well as OS (P = .1) in the upfront surgery group. Conclusion A customized approach pivoted on image‐based high‐risk features facilitates identification of patients with early‐stage renal tumor when the timing of surgery is tailored. Moreover, non‐Wilms tumor and high‐risk pathology are also identified.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Customized approach for upfront or delayed resection using radiological criteria in unilateral, nonmetastatic pediatric renal tumors: A prospective study

Qureshi

Kembhavi

Bhagat

et al. 2019

Pediatric Blood & Cancer

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“…WT patients usually have a good prognosis, with an overall survival of over 90% [12], due partially to advances in treatment stemming from recommendations by the National Wilms Tumor Study Group (NWTS) and the International Society of Paediatric Oncology (SIOP) [3,[13][14][15][16]. However, few, if any, studies have specifically focused on elucidating the association between Hispanic ethnicity and WT prognosis.…”

Section: Introductionmentioning

confidence: 98%

The Role of Hispanic Ethnicity in Pediatric Wilms’ Tumor Survival

Amirian

2013

Pediatric Hematology and Oncology

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Wilms' tumors (WT) constitute approximately 6-14% of all childhood cancers and about 95% of all pediatric renal malignancies. While prognostic factors for this malignancy are relatively well-defined, few studies have specifically examined the role of Hispanic ethnicity in pediatric WT survival. The purpose of this study was to compare WT survival among non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic cases using data from the Surveillance, Epidemiology, and End Results (SEER) program. WT cases (ICD-O-3 histological code 8960) under age 20 were isolated from a recent subset of the SEER dataset (1990-2009). Demographics and tumor characteristics were compared by race/ethnicity, and 5- and 10-year survival probabilities were calculated. Multivariable Cox proportional hazards regression was used to assess the effects of race/ethnicity on WT survival, adjusting for relevant covariates. Hispanic ethnicity was significantly associated with WT-specific mortality hazard, controlling for age, sex, diagnosis/treatment era, laterality, SEER stage, cancer-directed surgery, and radiation therapy (HR: 1.52, 95% CI: 1.02-2.25). The results of this study suggest that Hispanic pediatric WT cases may have a higher risk of WT-related death, compared to NHW cases. Additional research on racial/ethnic disparities in WT survival is warranted.

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“…The decision to proceed with upfront surgery (radical nephrectomy vs partial/nephron‐sparing surgery [NSS]) vs neoadjuvant chemotherapy (NaC) not only depends on which protocol is being followed, but also on patient variables such as the presence of unilateral vs bilateral disease and diagnosis of a genetic predisposition syndrome . In addition, tumour characteristics on imaging studies, such as involvement of adjacent structures, evidence of rupture, or involvement of renal vein and cava, are also factored into the initial management strategy .…”

Section: Introductionmentioning

confidence: 99%

“…Most children with WT present with a large abdominal mass which prompts cross‐sectional imaging (CT or MRI) to identify tumour origin, size and spread . Imaging is then repeated at specific time intervals, including post‐NaC and postoperatively, to monitor response to treatment and detect recurrences.…”

Section: Introductionmentioning

confidence: 99%

Volumetric assessment of unaffected parenchyma and Wilms’ tumours: analysis of response to chemotherapy and surgery using a semi‐automated segmentation algorithm in children with renal neoplasms

et al. 2020

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ConclusionVolumetric analysis is feasible and allows objective assessment of tumour and parenchyma volume in response to chemotherapy and surgery. Our data show changes after therapy that may be otherwise difficult to quantify. Use of such technology may improve surgical planning and quantification of response to treatment, as well as serving as a tool to predict renal reserve and long-term changes in renal function.Additional Supporting Information may be found in the online version of this article: Data S1. Detailed description of segmentation methodology.

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Understanding the principles in management of Wilms' tumour: Can imaging assist in patient selection?

Cited by 21 publications

References 30 publications

Customized approach for upfront or delayed resection using radiological criteria in unilateral, nonmetastatic pediatric renal tumors: A prospective study

Customized approach for upfront or delayed resection using radiological criteria in unilateral, nonmetastatic pediatric renal tumors: A prospective study

The Role of Hispanic Ethnicity in Pediatric Wilms’ Tumor Survival

Volumetric assessment of unaffected parenchyma and Wilms’ tumours: analysis of response to chemotherapy and surgery using a semi‐automated segmentation algorithm in children with renal neoplasms

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