SIOP treatment guidelines for renal tumours in small infants: fact or fantasy?

Since as far back as 1980, SIOP (Société Internationale d>>Oncologie Pédiatrique) have advocated primary nephrectomy (PN) only for unilateral renal tumours in patients

Retrospective analysis of 67 patients under 12 months of age (1969-1995) with a unilateral renal tumour at diagnosis was carried out. Demographics, pathology, staging and treatment variables were analysed.

Of 67 patients, 39 were male and 28 female. Twenty-six (39%) infants were 0-6 months of age (group A) and 41 (61%) were 7-12 months old (group B). In group A there were five patients (19%) with congenital mesoblastic nephroma (CMN), out of which one was still-born and therefore received no treatment, and 21 patients with a unilateral Wilms>> tumour (WT). Fourteen of the 25 patients (56%) were treated with PN, including four patients with CMN. In group B there was one patient (2%) with CMN and 40 patients with WT. Thirteen of the patients (31%) were treated with PN. A total of 15 patients were treated before 1980 and 26 after 1980. Eight of 15 (53%) patients were treated with PN before 1980 and 21/26 (81%) were pre-treated after 1980, according to the protocol.

Despite the SIOP recommendations, only 56% of patients