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Wilms' tumour: pre- and post-chemotherapy CT appearances
Y Y Ng1, M A Hall-Craggs, C Dicks-Mireaux
1Department of Radiology, Hospital for Sick Children, London.
Clinical Radiology
|April 1, 1991
Summary
Pre-operative chemotherapy for Wilms' tumours (WT) can shrink tumors by over 50% and cause cystic changes. Computed tomography (CT) effectively monitors these treatment effects but has limitations in assessing lymph node involvement and liver invasion.
Area of Science:
- Pediatric Oncology
- Radiology
- Medical Imaging
Background:
- Pre-operative chemotherapy is a standard treatment for Wilms' tumours (WT) when surgical resection is uncertain.
- The computed tomographic (CT) imaging characteristics of chemotherapy-induced changes in WT have not been previously documented.
Purpose of the Study:
- To analyze the CT findings in children with WT who received pre-operative chemotherapy.
- To assess the impact of chemotherapy on tumour size, extent, and qualitative features.
Main Methods:
- Retrospective analysis of CT scans from 18 children with WT.
- Evaluation of tumour size reduction, presence of cystic changes, lymph node status, and liver invasion before and after chemotherapy.
Main Results:
- Clinical response correlated with a tumor size reduction of at least 50%.
- Cystic degeneration within the tumour was a common post-chemotherapy finding.
- CT imaging showed limitations in differentiating between lymph nodes with tumour involvement and reactive lymphadenopathy.
- Pre-chemotherapy CT scans inaccurately predicted liver invasion in 22% of cases.
Conclusions:
- CT is valuable for monitoring pre-operative chemotherapy response in Wilms' tumours, particularly regarding tumor size reduction and cystic changes.
- Radiologists should be aware of CT's limitations in evaluating lymph node status and predicting liver invasion in the context of neoadjuvant chemotherapy for WT.