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Bilateral Wilms' tumors: changing concepts in management
J M Laberge1, L T Nguyen, Y L Homsy
1Pediatric Urology Service, Hôpital Sainte-Justine, Montreal, Quebec, Canada.
Journal of Pediatric Surgery
|August 1, 1987
Summary
Synchronous bilateral Wilms
Area of Science:
- Pediatric Oncology
- Nephrology
- Surgical Oncology
Background:
- Wilms' tumor, a rare pediatric kidney cancer, infrequently presents bilaterally.
- Synchronous bilateral Wilms' tumor (nephroblastoma) is a challenging clinical scenario.
Observation:
- A 20-year retrospective review identified nine cases of synchronous bilateral nephroblastoma (Stage V).
- Patients ranged from 9 to 41 months old, with associated findings including nephroblastomatosis and familial history in some.
- Treatment involved multimodal approaches including surgery, chemotherapy (e.g., actinomycin D, vincristine), and radiation therapy.
Findings:
- Seven of nine patients (77%) survived over two years, with five achieving long-term disease-free survival.
- Treatment aggressiveness was tailored based on tumor stage and histology.
- Effective chemotherapy facilitated maximal preservation of renal parenchyma in early-stage tumors.
Implications:
- Multimodal therapy can be effectively tailored for synchronous bilateral Wilms' tumor.
- Maximal renal parenchyma preservation is achievable with appropriate chemotherapy for early-stage disease.
- Long-term survival is possible, though complications like chronic renal failure can occur.