Pulmonary metastases in Wilms' tumour

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Medical Oncology

Background:

• Wilms' tumour is a common pediatric kidney cancer.
• Pulmonary metastases are a significant cause of mortality in Wilms' tumour.
• Treatment strategies have evolved over time, necessitating analysis of historical data.

Purpose of the Study:

• To analyze the incidence and outcomes of pulmonary metastases in pediatric patients with Wilms' tumour.
• To correlate local tumour stage with the development of distant metastases.
• To evaluate the effectiveness of different treatment modalities for pulmonary metastases.

Main Methods:

• Retrospective analysis of 87 patients diagnosed with Wilms' tumour between 1960 and 1973.
• Data collection on initial diagnosis, tumour staging, development of pulmonary metastases, and treatment received.
• Survival rates were analyzed based on metastasis status, tumour stage, and treatment interventions.

Main Results:

• 15 patients (17%) had pulmonary metastases at diagnosis, and 22 (25%) developed them within 18 months post-nephrectomy.
• Locally advanced primary tumours were associated with a higher incidence of pulmonary metastases.
• Disease-free survival was strongly linked to initial local tumour staging.
• Surgical resection of solitary pulmonary metastases (seen in localized primary tumours) yielded the highest survival rate (5/6).
• Multiple pulmonary metastases, treated with irradiation and single-agent chemotherapy, had poor outcomes (6/31 disease-free survivors), often associated with abdominal recurrence in advanced primary tumours.

Conclusions:

• Wilms' tumour stage significantly impacts the risk of pulmonary metastasis.
• Solitary pulmonary metastases, particularly in localized primary tumours, benefit from surgical resection.
• Multiple pulmonary metastases and advanced primary tumours necessitate aggressive multimodal therapy, including combination chemotherapy, surgery, and radiotherapy.